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Full text of "Answers to questions prescribed by dental state boards"





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ANSWERS 



TO 



QUESTIONS PRESCRIBED 



BY 



DENTAL STATE BOARDS. 



BY 

ROBERT B. LUDY, M. D., 

LATE ACTING-ASSISTANT SURGEON, U. S. A., LKCTURER ON PRACTICE OF MEDICINE IN 

TEMPLE COLLEGE OF PHILADELPHIA, AUTHOR OF "ANSWERS TO QUESTIONS 

PRESCRIBED BY MEDICAL STATE BOARDS," " ANSWERS TO QUESTIONS 

PRESCRIBED BY PHARMACEUTICAL STATE BOARDS," ETC. 



THIRD EDITION, REWRITTEN AND ENLARGED. 



PHILADELPHIA : 

JOHN JOS. McVEY. 
1907. 



:ntal schc 

... 






Entered according to Act of Congress, in the year ihot 

By JOHN JOS. McVKY. 

In tin i (ffice "i the Librarian at Washington. I). C. 



PREFACE TO THE THIRD EDITION. 



I have carefully revised this book for the third edition, and 
have made numerous additions which have been rendered neces- 
sary by new questions given by different State Boards. 

Robert B. Ludy. 
(hi) 



PREFACE TO THE SECOND EDITION. 



The endorsement of the first edition of this hook by teachers 
and students, as shown by numerous expressions of approval, 
as well as by its rapid sale, is extremely gratifying to the author 
and seems to warrant its continuance. 

In the present edition the entire text has been completely 
rewritten and thoroughly revised, and all new State Board 
Questions which appeared since the publication of the first 
edition have been added. It is hoped that the careful revision 
to which the work has been subjected has eliminated the errors 
which appeared in the first edition. 

Many persons having an adequate knowledge of the subject 
in which they are tested, fail, because of their inability to in- 
terpret properly the intents and purposes of the questions to be 
answered by them. To aid in this, as well as to afford a con- 
venient manual for the general preparation of Dental Students 
in their work, is the sole object of this book. 

Having collected a large number of questions from different 
States, it was found that duplications occurred ranging from 
30 per cent, to 80 per cent., varying according to the several 
subjects. Thus a comprehensive knowledge of these questions 
and answers will serve excellently in the preparation for future 
examinations before such Boards. 

In order to secure a critical interpretation of the questions, 
and concise, yet complete, answers to the same, the author has 
been favored by the assistance of well-known specialists in their 
several lines, whose competence and experience give to the work 
a range and value impossible of attainment in the product of a 
single author. 

It has been deemed advisable to unite all questions from the 

(iv) 



PREFACE. V 

different States under their respective headings, so that undue 
repetitions of similar questions might be avoided. 

Although standard literature has necessarily been consulted, 
yet, in a work of this character, references would only prove 
cumbersome; hence they have been generally omitted. 

To Drs. Boom, Buckley, Good, Northrop, Rice, Salvas and 
Thomas, the author makes grateful acknowledgment. The high 
value of their carefully prepared answers is fully appreciated 
by him, and will be, he is assured, by those into whose hands 
the work is committed. 

Robert B. Ludy. 



SPECIAL AUTHORS. 



Henry H. Boom, M. D. 

Professor of Chemistry. Physics and Metallurgy in the Philadelphia 

Dental College. 

Albert C. Buckley, A. M„ M. D. 

Associate Professor of Histology in the Medico-Chirurgical College 
of Philadelphia. 

Win. Harmar Good, A. B., M. J). 

Demonstrator in Physiology at the Medico-Chirurgical College of 
Philadelphia. 

Herbert L. Northrop, M. />. 

Professor of Anatomy and Associate Professor of Surgery in Hahne- 
mann Medical College of Philadelphia. 

Earl C. Rice, D. D. & 

Late Professor of Dental Pathology and Therapeutics in the Medico- 
Chirurgical College of Philadelphia. 

»/. Clarence Salvas, I). D. S. 

Philadelphia. 

W. Hersey Thomas, M. Z>. 

Lecturer on Surgery, Medico-Chirurgical College; Assistant Surgeon 
to Medico-Chirurgical and Philadelphia Hospitals. 

( vi) 



CONTENTS. 



PAGE 

I. OPERATIVE DENTISTRY 1 

By J. Clarence Salvas, D. D. S. 

II. PROSTHETIC DENTISTRY 43 

Ry J. Clarence Salvas, D. D. S. 

III. ORAL SURGERY 101 

By W. Hersey Thomas, M. D. 

IV. PATHOLOGY 183 

By W. Hersey Thomas. M. D. 

V. PATHOLOGY AND THERAPEUTICS 207 

By Earl C. Rice, D. D. S. 

VI. THERAPEUTICS AND MATERIA MEDICA 221 

By Earl C. Rice, D. D. S. 

VII. PHYSICS, CHEMISTRY AND METALLURGY 263 

By Henry H. Boom, M. D. 

VIII. HISTOLOGY 341 

By Albert C. Buckley, A. M., M. D. 

IX. PHYSIOLOGY 379 

By William Harmar Good, A. B. , M. D. 

X. HYGIENE 415 

By Robert B. Ludy, M. D. 

XI. ANATOMY 441 

By Herbert L. Northrop, M. D. 

(vii) 



OPERATIVE DENTISTRY. 



What is dental caries? 

Dental caries is the disintegration of tooth tissue. 

Give the etiology and the general preventive treatment 
of dental caries. 

Lactic fermentation. Thorough cleansing of the teeth by 
means of tooth-brushes, powder, dental floss and antiseptic 
washes. 

How is dental caries classified? 

It is classified as follows : Superficial, deep-seated, simple 
and complicated. 

What is superficial dental caries? Give treatment. 

It is that stage of the disease in which the caries has not 
penetrated the enamel. The treatment consists in its removal 
with disks and fine stones. 

What is deep=seated dental caries? Give treatment. 

It is that stage of the disease which involves the zone of 
dentin in close proximity to the pulp-chamber. 

Removal of all decay, sterilization, coating the cavity with 
a cavity-lining and filling. 

Give the etiology, prognosis and treatment of inflam- 
mation of the membranes of the mouth preparatory to 
operations on the teeth. 

The local causes of inflammatory conditions of the mem- 
branes of the mouth are due to the presence of salivary cal- 
culus, to carious, loose, dead or diseased teeth or roots. 

(1) 



2 OPERATIVE DENTISTRY. 

The prognosis is favorable. The treatment consists in the 
mechanical removal of the deposits on the surfaces of the 
teeth, and in the extraction of incurably-diseased teeth. The 
gums should be massaged at each sitting and the parts 
sprayed several times a day with the following well-diluted 
antiseptic solution : 

Euformol 3 j 

Glycothymoline ^ iv 

Acidi carb gttxxx 

Where the inflammatory condition is the expression of 
constitutional disorder, derangement of the alimentary func- 
tions or catarrhal affection, general treatment is indicated. 

Give a general rule for the preparation and formation 
of cavities. Name the points that require special care in 
excavating. 

All frail overhanging walls should be removed, the cavity 
thoroughly excavated, sterilized, and made retentive in form. 
The margins should be smoothed. Care must be taken, while 
excavating, not to expose the pulp. 

Give the recognized stages in the preparation of a cavity 
for filling. 

The recognized stages are : Opening the cavity, removing 
the decay, shaping the cavity. 

Give the general principles governing (a) the prepara= 
tion of cavities for gold fillings, (b) the insertion of gold 
fillings. 

(a) Opening the cavity; removal of the decay; shaping 
the cavity to receive and retain the filling, and the prepara- 
tion of the margins. 

(&) Accurate adaptation to the cavity walls; solidity and 
proper contour. 

How should the preparation of a cavity for a gold filling 



OPERATIVE DENTISTRY. 3 

differ from the preparation of a cavity for an amalgam 
filling? 

A cavity for gold requires direct access; the walls should 
be strong, and the margins smooth and beveled. Retention 
should be secured by well-defined pits or grooves drilled in 
the dentin. 

A cavity for amalgam should be more or less ball-shaped ; 
the cavity should be enlarged from within, the enamel-walls 
parallel, the angles removed and straight sides made concave. 

What form of burs is preferable for removing deep= 
seated decay? Give reason for using this form and state 
method of use. 

The round or oval form of burs. They are preferable be- 
cause their form is similar to that of the natural outline of 
the cavity and, when properly used, they are not so apt to 
injure the subjacent dentin. They are manipulated by means 
of the handpiece of the engine and should revolve rapidly. 
The instrument should be lifted at short intervals and allowed 
to run free, to avoid heat from friction, and consequent pain. 

What instruments should be used to smooth or finish 
cavity margins? 

Chisels, broad-faced excavators, approximal trimmers, and 
file-cut enamel finishing-burs, Arkansas stones, etc. 

What form of bur should be used (a) for opening and 
following the course of sulci; (b) for forming the floor of 
a cavity for a gold filling? 

(a) The fissure-bur; (b) the inverted cone. 

Mention the form and advantage of excavator points 
for removing deep=seated decay in teeth. 

Spoon-shaped or round-bladed. Their cutting edge being 
oval or circular in form, the layers of decayed tissue can be 
removed without injuring the subjacent tissue. 

Describe the method of excavating a cavity extending 



4 OPERATIVE DENTISTRY. 

to the pulp, giving the form of excavator and the manner 
of use. 

The orifice of the cavity is enlarged and, with a round- 
bladed excavator, the decay is removed just below the enamel 
line. The remaining portion of the carious dentin is re- 
moved by placing the blade of the excavator near the base 
of the cavity and with draw-cuts towards the orifice each 
layer of decay is removed. 

Round-bladed excavators of various shapes, according to 
the position of the cavity, are used. 

Give the general treatment and care of teeth in case of 
white decay. 

The carious matter should be carefully removed and the 
cavity sterilized, after which it should be filled with perma- 
nent gutta-percha or some other plastic. Teeth prone to this 
kind of decay should be subjected to frequent examination. 

Describe your method of preparing and filling approx- 
imal cavities in bicuspids and molars. 

Access to the cavity is secured by separating the teeth. If 
the occlusal surface is weak, it should be removed, thus con- 
verting the cavity into a compound cavity. All decalcified 
tooth structure is removed. Frail walls should be trimmed 
away and the cervical aspect of the cavity extended so as 
to secure a solid base. The floor of the cavity is made flat, 
avoiding sharp angles. The occlusal portion of the cavity 
should have a V shape, and the margins should be beveled 
and smoothed. A retaining groove or pit should be placed 
at the cervical termination of the cavity and slight under- 
cuts made in the approximo-occlusal walls. The rubber dam 
and the matrix adjusted, a mat of crystal or fiber gold is 
introduced and with a foot-shaped plugger malleted to place, 
care being taken to carry the gold over the cervical wall. By 
this method the upper third of the cavity is filled. Cohesive 
gold is then added and used to complete the remainder of the 



OPERATIVE DENTISTRY. 5 

filling, which should be contoured the natural shape of the 
tooth. The gold should be well burnished and polished with 
strips and sandpaper disks. 

In simple approximal cavities the cavity should be ex- 
tended buccally, so that it can be approached from the buccal 
aspect. The decay and the margins should be treated as be- 
fore described. With an inverted cone-drill the cavity can be 
made retentive in form and crystal or fiber gold inserted. 

How would you prepare and fill an approximal cavity 
with frail walls extending to the cutting edge of an in- 
cisor? 

The cavity should be thoroughly excavated and all frail 
margins of enamel should be removed. The labial margin 
of the cavity is brought to the cutting edge in a direct line, 
the cervical aspect of the cavity shaped as a flat ledge, the 
base at right angles with the axis of the tooth. The lingual 
margin should correspond to that of the labial to within a 
few lines of the cutting edge, where it should turn at right 
angles and extend across the tooth at the cutting edge to a 
point a little beyond the depth of the cavity. Anchorage is 
obtained by cutting a groove in the cervical ledge and by 
making an undercut in the dentin near the incisal border. 
The margins should be bevelled and smoothed. Cohesive 
gold in the form of ropes or cylinders is used. The cervical 
groove is filled first and the gold built down towards the 
incisal edge, where it is securely anchored. The mass should 
be kept on a line with the labial and palatal walls. The gold 
should be carried well over the margins and thoroughly con- 
densed with a broad-faced plugger, using sufficient to permit 
of proper shaping and finishing. 

How should cervical cavities be prepared with reference 
to the gum margin? 

The margin should be extended well rootwards in order 
to include any defect in the enamel bordering it. The walls 
should be made smooth and free from angles. 



6 OPERATIVE DENTISTRY. 

By what means can cavities be protected from moisture 
without recourse to the rubber dam? 

By the use of cottonoid or small linen napkins in conjunc- 
tion with the saliva-ejector. 

What is hypersensitive dentin? Give treatment. 

It is an irritated state of the tubular contents of the dentin 
and prevails principally near the junction of the dentin with 
the enamel. 

The cavity should be thoroughly dried by the use of abso- 
lute alcohol, followed by blasts of warm air; this may be 
followed by Robinson's remedy, caustic potassa and carbolic 
acid, equal parts. 

How should a cavity be treated and filled when the 
dentin is highly inflamed?* 

Oil of cloves should be sealed into the cavity for a few 
days, the decay then removed, using sharp instruments, and 
the cavity lined with "cavitine," after which it may be 
filled with cement. 

State the most efficient and satisfactory treatment of 
teeth that have become sensitive with a tendency to decay 
under plate clasps. 

The affected parts should be treated with a 25 per cent, 
solution of nitrate of silver. 

Describe the treatment of anterior teeth that are sen= 
sitive at the gingival border. 

An ant-acid mouth-wash should be prescribed and a solu- 
tion of glycerin and tannic acid applied to the sensitive part. 

Why does the contact of fillings of different metals re- 
sult in shock to the teeth? 

Because of a galvanic action taking place when the two 
metals are brought in contact. 

* This question is answered presuming that its author used the expression 
"highly inflamed dentin" as synonymous with hypersensitive dentin. In- 
flammation of the dentin, if there is such a pathological condition, has no 
bearing whatever on cavity preparation. 



OPERATIVE DENTISTRY. 7 

Why are teeth recently filled more liable to shock from 
thermal changes than other teeth? Give preventive treat- 
ment. 

It is because of the immediate contact of a filling, especially 
a metallic filling, with the tubular structure of the dentin. 
It may be prevented by interposing a layer of non-conductive 
material. 

Describe the treatment of a tooth that is extremely sen= 
sitive to thermal changes after filling. 

A gutta-percha cap placed over the affected tooth and 
allowed to remain until the pulp recovers from the hyper- 
emia. When the severity and continuance of the pain is 
such as would give rise to inflammation, the filling should 
be removed and the cavity treated, after which it should be 
lined with a cavity-lining and a soft filling inserted. 

Give the cause and treatment of pits on the labial sur- 
face of teeth near the incisal edge. 

They are caused by imperfect development of the enamel. 
If the pits are shallow, they may be obliterated by grinding 
the surface with a corundum wheel, converting the surface 
at this point into a distinct concavity. When the pits are 
deeper, they are enlarged and filled. 

What is erosion? Give its cause and treatment. 

It is a chemical disintegration of tooth tissue, occurring 
principally upon the labial surfaces of the teeth. It is 
caused by the action of an acid secretion, the motion of the 
lips assisting in the disintegration process. 

The treatment consists in prescribing an ant-acid mouth- 
wash. When the disintegration involves the dentin to any 
extent, the cavity is prepared and filled. 

Define abrasion. State causes and give method of 
restoration. 

Abrasion is a mechanical wearing of the crowns of the 
teeth. It is caused by defective occlusion and excessive wear. 



8 OPERATIVE DENTISTRY. 

Restoration is effected by the adjustment of crowns or porce- 
lain tips, etc. 

Is the deposit of secondary dentin physiologic or path- 
ologic? 

It is physiologic. 

What is meant by the term " eburnation "? 

The process by which the dentinal tubuli become obliter- 
ated by calcific deposits. 

How should teeth be separated for the purpose of in- 
serting a filling? 

By means of pellets of cotton, linen tape, strips of caout- 
chouc or by the mechanical separator. 

What pathologic condition may result from wedging 
teeth? 

Disorganization and consequent death of the pulp. 

Why are the risks especially great in rapid wedging of 
the superior central incisors? 

Because there may occur a separation of the superior 
maxilla and the possibility of the incisors not returning to 
their normal position. 

How should teeth that have been wedged be guarded to 
prevent injury during the process of filling? 

They should be held firmly in place by means of orange 
wood, gutta-percha or phosphate of zinc. 

What is the best treatment to render a cavity aseptic? 

The removal of decay and the application of carbolic acid. 

Name the different materials used in filling teeth. 

Oxysulphate of zinc, oxychloride of zinc, oxyphosphate of 
zinc, oxyphosphate of copper, gutta-percha, amalgam, tin, 
gold and porcelain. 



OPERATIVE DENTISTRY. 9 

What advantages has gutta=percha as a filling material? 

It is non-conductive, non-irritating, insoluble, and easily 
manipulated. 

In what class of cavities should gutta=percha rather 
than metallic fillings be used? 

In deep cavities upon the buccal surfaces of molars ex- 
tending beneath the gum and not involving the masticating 
surface; in approximal cavities of the anterior teeth extend- 
ing beneath the gum, in labial cavities, especially in teeth 
which are loose. 

Describe the insertion and finishing of a gutta=percha 
filling. 

The gutta-percha should be softened by warming it over a 
suitable device, after which it is introduced piece by piece, 
using broad-faced instruments, care being taken to adapt the 
gutta-percha to the margins of the cavity. The finishing con- 
sists in trimming the portions overlying the margins with a 
warm instrument. The instrument should be directed to- 
wards the margin and not from it. 

For what class of teeth and for what operations is phos= 
phate of zinc valuable? 

For children's teeth and as a temporary filling in per- 
manent teeth ; in frail teeth with extensive cavities or as a 
lining to be covered with a metallic filling; as a retaining 
medium in crowns, bridge-work and porcelain inlays. 

In what class of cavities is cement unsafe? 

In cervical cavities. 

In what class of operations is the oxychloride of zinc 
indicated? 

In filling root-canals, capping pulps and lining cavities. 

State the advantages of amalgam over the other plastic 
fillings. Give reasons. 

It is more durable and possesses a wider range of appli- 



10 OPERATIVE DENTISTRY. 

cation, which is due to its insolubility and its property of 
withstanding the stress of mastication. 

State the conditions under which amalgam should be 
used for fillings. Give reasons. 

Wherever it is not exposed to view or where gold is contra- 
indicated. Its unsatisfactory color excludes it as a filling 
for the anterior teeth. 

Describe the method of preparing and inserting an 
amalgam filling. 

The alloy and the mercury in proper proportions are placed 
in a mortar and with a pestle the mass is mixed. When 
amalgamation is completed, it is transferred to the palm of 
the hand and kneaded with the fingers, after which the sur- 
plus mercury is squeezed out. It is introduced into the 
cavity in small pieces and pressed against the walls by 
tapping or burnishing. When the cavity is filled, the edges 
are neatly trimmed with pieces of punk. The filling should 
be polished at a subsequent sitting. 

How should the margins of a cavity wall be prepared 
for an amalgam filling? 

The margin should be so prepared that the amalgam in its 
adaptation is not worked to a feather edge. 

What are the physical changes in an amalgam filling 
after it is placed in a tooth? 

Crystallization, contraction and expansion. 

How should an amalgam filling in a compound cavity, 
involving the approximal and masticating surfaces of a 
molar, be inserted? 

A matrix should be adjusted and the amalgam introduced 
from the masticating surface, care being taken to have it well 
burnished against the matrix and the margins of the cavity. 

What advantage has amalgam over gold for filling teeth? 

The plastic nature of the amalgam renders its introduction 



OPERATIVE DENTISTRY. 11 

simpler and quicker. In cavities difficult of access it can be 
better adapted to tbe margins. 

Under what conditions are the plastic fillings preferable 
to gold? 

When the dentin is in a hypersensitive condition; when 
the cavity encroaches upon the pulp-chamber; in frail teeth 
and in deciduous teeth. 

In what class of cavities is tin preferable for filling? 

In temporary teeth. 

Describe method of inserting a filling of tin. 

The tooth should be isolated with the rubber dam, the tin 
introduced in strips or rolls, using shallow but well-defined 
serrated points. The tin is carried to the floor and walls of 
the cavity, and by the wedging process it is thoroughly 
adapted. As the filling approaches the marginal surface, 
broader points and condensers are employed. The surface 
should be well burnished and the filling finished by means of 
fine stones and disks. 

State why tin fillings arrest decay in teeth when gold 
fillings fail? 

Because the tin possesses antiseptic properties and, owing 
to its softness, is better adapted to the walls of the cavity. 

What are the characteristics that render gold such a 
desirable filling material? 

Pliability, softness, tenacity and agreeableness of color. 

What advantages has gold over the other materials used 
for fillings? 

It possesses better edge strength, it is not affected by the 
oral fluids, and it retains its form when properly inserted. 

How should a cavity be prepared for a gold filling? 

Frail walls should be removed, the cavity thoroughly ex- 
cavated, and the margins carefully bevelled and smoothed. 
Anchorage is obtained by deepening the cavity at its cervical 



12 OPERATIVE DENTISTRY. 

termination and by making a shallow groove in the dentin 
near the ineisal or occlusal border. 

What special precautions should be observed in insert- 
ing gold fillings in approximal cavities? 

They should conform to the natural shape of the tooth and 
should be as inconspicuous as possible. 

What is the difference between cohesive and non= 
cohesive gold? State the working method of each. 

Cohesive gold is a preparation of gold which possesses the 
property of cohesion. It is worked on the welding principle. 

Non-cohesive gold does not possess the property of cohesion. 
It is worked on the wedging principle. 

In what respect is non=cohesive gold preferable to co- 
hesive gold for filling teeth? 

It is more readily adapted to the walls of the cavity. 
State the advantages of cohesive gold? Give reasons. 

Owing to its cohesive property the pieces may be welded 
one to another; thus a filling of any size or shape can be 
made with it. 

Give the technic of preparing and filling with cohesive 
gold an approximal cavity. 

The teeth are separated until sufficient space is secured, 
the rubber dam adjusted and the frail walls on the approx- 
imal surface broken away with a small chisel, care being 
taken to preserve as much of the labial wall as possible. 
After the decay has been removed, using burs or excavators, 
the margins should be bevelled and smoothed by means of 
plug-finishing burs. Anchorage is obtained by grooving the 
dentin at the cervical termination, using small, inverted cone- 
burs, and by making a shallow undercut in the dentin near 
the ineisal border. The gold is introduced in small pieces, 
packed into the groove at the cervical border, using shallow, 
serrated plugger-points. When firmly anchored, the gold is 
built along the floor and the palatal wall to the ineisal groove. 



OPERATIVE DENTISTRY. 13 

The construction of the filling along the palatal wall should 
precede that of the labial aspect of the cavity, thus facili- 
tating contouring. "When the filling approaches the labial 
margins of the cavity, a shallow, serrated foot-plugger should 
be used for the remainder of the operation. The pellets of 
gold should be laid in regular order and carried well over 
the margin of the cavity, care being taken not to allow the 
plugger to come in contact with the enamel. 
Where would you use non=cohesive gold? 

In occlusal, buccal, lingual, labial and simple approximal 
cavities ; also as a lining in cavities with frail walls in com- 
bination with cohesive gold. It is especially serviceable in 
minute cavities and in those difficult of access. 

Give the technic of preparing and filling an approximal 
cavity with non=cohesive gold. 

Access to the cavity is secured by separating the teeth. 
The cavity is excavated by means of rose-head burs and 
spoon-shaped excavators. It should be made oval or circular 
in form, the margins bevelled and smoothed, and the floor 
of the cavity made flat and larger than the orifice, employing 
for this purpose the inverted cone-shaped bur. The gold is 
introduced in strips or rolls, using broad, well-serrated plug- 
gers and by means of hand-pressure. Considerable and well 
directed force is essential. 

Describe a method of securely anchoring a gold filling 
in a distal cavity with frail palatal walls in a vital supe= 
rior cuspid. 

Anchorage is secured by cutting grooves in the dentin at 
the cervical border and by cutting an extension-arm in the 
palatal surface near the incisal edge. 

Describe a method of filling an occlusal cavity in a 
molar with shallow sulci radiating from a deep central 
cavity. Describe the form and condition of gold used in 
the operation. 

The central portion of the cavity should be filled with 



14 OPERATIVE DENTISTRY. 

semi-cohesive foil and the radiating sulci with cohesive foil, 
care being taken to have the filling well anchored at the ex- 
tremities of the fissures. 

State the best method of applying gold to the walls of 
cavities in poorly calcified teeth. 

Cavities in teeth of this character should be lined with 
oxyphosphate. While the cement is still soft, pieces of plas- 
tic gold are pressed into it, and the surplus cement carefully 
removed. When the cement has become hard, the pieces of 
plastic gold are thoroughly condensed and the filling com- 
pleted with cohesive foil. 

Give method of treating and filling a very sensitive 
superficial cavity with gold. 

The sensitiveness is relieved by the use of carbolic acid 
and blasts of warm air, after which the cavity is prepared 
and coated with a solution of Canada balsam and chloro- 
form. It should then be filled with either non-cohesive or 
with plastic gold. 

Mention the class of cavities in which a combination 
of non=cohesive and cohesive gold should be used. Give 
reason for their use. 

A combination of non-cohesive and cohesive gold is indicated 
in approximal cavities with frail walls, in meso-occlusal and 
disto-occlusal, in occluso-buccal and occluso-lingual cavities. 

The advantage of employing non-cohesive and cohesive 
gold in combination is, that the non-cohesive can be easier 
and better adapted to the floor and margins of the cavity, 
while with the cohesive gold for finishing the filling, contour 
and greater density is obtained. 

Give the technic of filling a cavity with a combination 
of cohesive and non=cohesive gold. 

Where a matrix is indicated, this device is adjusted, the 
tooth having been previously isolated with the rubber dam. 
The cavity prepared, a roll or mat of non-cohesive gold is 



OPERATIVE DENTISTRY. 15 

placed in the cavity, extending some distance beyond the cer- 
vical border. This is followed by one or more rolls, which 
should be malleted into place, using a foot-shaped plugger. 
This is continued till a third of the cavity is filled, when 
very cohesive gold is introduced and the filling completed, 
using slightly serrated plugger-points. The gold should be 
carried well beyond the beveled margin on the occlusal sur- 
face and thoroughly condensed with a small, finely-serrated 
foot-plugger. 

What causes the surface of gold fillings to blacken in 
some mouths? 

The action of sulphites, either taken with the food or pro- 
duced chemically in the mouth ; the incorporation of foreign 
substances with the gold during its insertion ; imperfectly 
prepared cavities, where the gold next to the floor and walls 
of the cavity, if poorly condensed, will absorb more or less 
of the carious products. The contamination of the gold with 
mercury, owing to the use of an amalgam-burnisher, is also 
a potent factor in causing discoloration of gold fillings. 

When the walls of a cavity have softened beneath an 
approximal gold filling extending beneath the gums, how 
should the cavity be treated and filled? 

The softened tissue is thoroughly removed, extending the 
cavity well rootward, space having been previously secured 
and the gums forced away. The repair can then be made 
either with permanent gutta-percha or with plastic gold. 

Mention the various combination fillings and state the 
advantage of their use. 

Gutta-percha and cement, amalgam and cement, gold and 
cement, gold and amalgam, gold and tin, and the different 
forms of gold in combination. The advantage of combining 
filling materials consists in the elimination of the disadvan- 
tages of each when used separately, and in the utilizing the 
advantages of each when in combination. 



16 OPERATIVE DENTISTRY. 

Designate a class of cavities in frail teeth when a com- 
bination filling of gutta=percha and zinc phosphate is in- 
dicated and give technic of operation. 

In those cavities that extend beneath the gum. The rubber 
dam and matrix is adjusted, the latter to prevent the gutta- 
percha from being forced out into the soft tissue. The cavity 
is excavated, sterilized and coated with Canada balsam dis- 
solved in chloroform. The cervical margin is then filled with 
gutta-percha and the remainder of the cavity with cement. 
"When sufficiently hard, it is polished and coated with melted 
paraffin. 

Give the technic of filling with gold and tin. 

The tin is introduced into the cavity in strips or rolls and 
with a short foot-plugger it is condensed against the floor 
and lower walls, carrying it over the cervical wall. Non- 
cohesive gold is then inserted in the same manner until two- 
thirds of the cavity is filled. The remainder of the cavity 
is filled with cohesive gold, which is contoured the natural 
shape of a tooth. Or a sheet of tin-foil may be placed be- 
tween two sheets of gold and the whole folded and used as 
would be gold or tin alone. 

Describe a method of restoring with a combination of 
gold and cement badly=decayed, frail crowns of teeth. 

The rubber dam adjusted and the cavity margins bevelled, 
the lower third of the cavity and the walls are lined with 
a quick-setting cement, When the cement is hard, retaining- 
grooves are made and the gold introduced, and the filling 
finished in the usual manner. 

Mention the class of operations in which a combination 
of gold and amalgam is preferable to either material used 
separately. Give reason. 

In cavities involving the disto-occlusal surface of bicuspids 
and the meso-occlusal surface of molars. Amalgam alone is 
objectionable owing to its color. It is, however, valuable in 
filling the cervical borders of cavities difficult of access. Be- 



OPERATIVE DENTISTRY. 17 

cause of its plastic nature, adaptation to the margins is better 
and more easily secured than with gold alone. 

Give technic for inserting a combination filling of gold 
and amalgam. 

The matrix and rubber dam are adjusted and the cavity 
sterilized and dried. A quick-setting amalgam is introduced 
and burnished well against the floor and lower walls, filling 
in this way a third of the cavity. A rope of non-cohesive 
gold is then inserted, holding it in place with one hand, while 
with the other it is packed on the amalgam and against the 
walls, using an oval-shaped foot-plugger. Several layers of 
this gold are used ; the filling is finished with cohesive gold. 

Describe in detail the method of restoring with a com= 
bination of amalgam and cement, frail broken crowns. 

The edges of the cavity should be carefully trimmed and 
the rubber dam adjusted. Amalgam sufficient to fill one-third 
of the cavity, is prepared. Before inserting it, two-thirds of 
the cavity are filled with soft cement, into which the amal- 
gam is placed, forcing the cement into every portion of the 
cavity. That which oozes out is carefully removed from the 
margins and the filling finished with amalgam. 

State in what class of cavities and under what condi= 
tions a matrix is essential. 

In distal compound cavities of bicuspids and molars. It is 
especially essential when plastics are employed. 

State the advantages and disadvantages of a matrix. 

It converts compound cavities into simple cavities and 
facilitates contouring. When employed in mesial cavities, it 
obstructs the light and makes it difficult to adapt the gold 
to the cavity margins. 

What are the comparative merits of hand and mallet 
pressure? 

Hand pressure permits of greater distribution of force,. 
2 



18 OPERATIVE DENTISTRY. 

which is essential in the condensation of the non-cohesive 
and the plastic golds. It produces less shock to the tooth and 
is less liable to injure the walls of the cavity when brought 
in contact with them. 

Mallet pressure permits of working with greater rapidity. 
It possesses marked penetrative force and gives greater den- 
sity to filling. 

Give technic of the operation of restoring teeth by the 
use of porcelain inlays. 

The cavity should be prepared so as to be free from under- 
cuts, the edges should be smooth and square. Where high- 
fusing porcelain is to be employed, the matrix must be made 
of rolled platinum one one-thousandth of an inch in thick- 
ness. It should be well annealed and placed over the cavity 
into which it is forced with a ball-burnisher or with a pellet 
of wet cotton, care being taken to have the margins smooth 
and sharply defined. The matrix is then removed and heated 
to redness in order to destroy all organic matter. The body 
should be thoroughly mixed with distilled water, dried with 
blotting-paper and placed in the matrix with a fine-pointed 
spatula. Tapping the pliers which hold the platinum will 
settle the body to the bottom. It is then dried by holding it 
a few seconds at the opening of the muffle, into which it is 
gradually introduced and baked until a gloss appears. When 
cool, it is placed in the cavity. The edges are now reban- 
ished and sufficient body is added to fill the matrix completely 
and to give the desired shape to the filling. It is dried and 
baked as before. The platinum should now be stripped off 
and the under surface grooved with fine disks. The cavity 
should be thoroughly dried and undercuts made, after which 
it is partially filled with cement and the inlay pressed home. 

How may excessive contraction be avoided in making 
large contour porcelain fillings? 

By imbedding one or two small chips of a porcelain tooth 
in the body mixed for the first baking. 



OPERATIVE DENTISTRY. 19 

What class of cavities and what condition of the teeth 
are most favorable for the insertion of porcelain inlays? 

Labial, buccal and simple approximal cavities. Frail and 
sensitive teeth. 

What are the advantages of the porcelain inlay as a 
filling material? 

It resists the action of the oral fluids, is non-conductive 
and possesses harmony of color and strength to withstand 
mastication. 

Describe a method of making gold inlays. 

An impression of the cavity should be taken in modeling 
compound and run in oxyphosphate of zinc. From this is 
made a matrix of No. 36-gauge pure gold, which is also 
burnished to fit the cavity in the tooth. It is then removed 
(the under surface should be coated with whiting to prevent 
the solder from flowing over the edge) and 22-carat solder 
flowed into the matrix, using enough to fill it partially. The 
contour or cusp, as the case may be, is obtained by placing 
in the matrix mats of crystal gold, and filling the interstices 
with 22-carat solder. The filling is then inserted in the same 
manner as porcelain inlay. 

In what class of cavities and in what condition of teeth 
is the gold inlay indicated? 

In frail teeth and in compound approximal cavities of bi- 
cuspids and molars. 

When are artificial crowns and bridges indicated and 
when not? 

A crown is indicated when filling materials fail to prop- 
erly restore a tooth to usefulness. It is counter-indicated 
when the root is diseased. 

When one or more teeth are to be inserted and proper 
anchorage can be secured, a bridge is indicated. When there 
are no desirable abutments and when gum tissue is to be 
restored, a bridge is counter-indicated. 



20 OPERATIVE DENTISTRY. 

(a) What is thermal test, (b) how is it conducted, (c) 
for what purposes is it useful? 

(a) Thermal test is the application of water to the teeth 
20 to 60 degrees F. below the blood-heat, and 20 to 50 de- 
grees F. above the blood-temperature. 

(&) The rubber dam is adjusted; cavities, if present, 
should be closed with a pellet of wet cotton. A stream of 
water is injected with a syringe. 

(c) To diagnose the condition of the pulp, also the degree 
of sensitiveness of the dentin. 

What is odontalgia? Of what is it the symptom? 

Odontalgia is pain in the tooth; it is the symptom of some 
functional or structural disturbance of the pulp. 

What methods should be employed to distinguish and 
locate odontalgia from idiopathic neuralgia? 

The thermal test, also tapping of the tooth. 

What are the characteristic symptoms of neuralgia aris- 
ing from a crowded denture? 

Reflex pain generally felt in the head and face and extend- 
ing down the neck. 

What is pulpitis? Give etiology and symptom. 

Inflammation of the pulp. It is caused by the invasion 
of bacteria, the close proximity of a filling, by a blow, or the 
continued irritation resulting from thermal changes. The 
symptom is severe pain, increased by the application of heat. 

Give treatment in case of pulpitis. 

In cases where the inflammation is acute in character, a 
pledget of cotton saturated with oil of cloves or creosote 
applied to the pulp and sealed in the cavity for a few days. 
The cavity is then carefully excavated, the pulp protected 
and the filling inserted. 

In cases of chronic pulpitis the inflammation should first 
be allayed by the application of oil of cloves, after which 
the pulp should be devitalized and extirpated. 



OPERATIVE DENTISTRY. 21 

How should a congested pulp be treated? 

If the congestion is acute, the pain may be allayed by an 
application of a sedative, the pulp capped and a temporary 
filling inserted. If the hypersemia is chronic, the congestion 
is relieved, after which the pulp is devitalized and extirpated. 

How should a freshly=exposed pulp be treated? 

The pulp and the adjacent tissues are thoroughly sterilized 
and the pulp capped. 

Give treatment of inflammation of the pulp in a supe= 
rior central incisor that has a gold filling in good condition 
in the approximal surface. 

The pulp-chamber is opened from the distal surface (the 
basilar pit), the inflammation subdued by applying formalin, 
3 per cent., after which the pulp is devitalized and extir- 
pated. 

Describe the method of treatment in painful pulp ex- 
posure. 

The inflammation is subdued by applications of eugenol 
and the pulp protected from external influences by dressings 
of cotton saturated with sandarac, after which the pulp is 
devitalized and removed. 

When is protection to the dental pulp from thermal 
changes indicated and how is it accomplished? 

"When a cavity is deep-seated or when a tooth is excessively 
sensitive to heat or cold. 

It is protected by means of a cavity-lining. In a tooth not 
affected by caries, the sensitive part — if in an inconspicuous 
place — is coated with a solution of nitrate of silver; in the 
anterior teeth with a solution of tannic acid and glycerin. 

How may irritation of the dental pulp be determined 
and located when there is no pulp exposure? 

By means of the thermal test and percussion. 

When the pulp of a tooth has sloughed, having dis- 



22 OPERATIVE DENTISTRY. 

charged through a cavity, how should it be treated and 
filled? 

The canal should be sterilized with a 4-per-cent. solution of 
formalin followed by sodium dioxid. It is then thoroughly 
scraped and washed with hot water, after which it is dried, 
using alcohol and warm air. A dressing of eugenol is sealed 
with temporary gutta-percha and removed once a week until 
all evidence of decomposition has disappeared, when the 
canal and cavity may be filled permanently. 

How may an inflamed pulp be diagnosed and located 
when no cavity exists? 

By isolating the tooth and the application of heat and per- 
cussion. 

When should a pulp be capped, and why? 

When it has been exposed, either accidentally or when the 
exposure is of recent origin, the result of caries, and then 
only in such cases where there has been no congestion and 
no evidence of inflammation. The object is to protect the 
pulp from pressure and to assist it in overcoming any bac- 
terial invasion with which it may have been affected. 

What symptoms would counter=indicate the capping of 
a pulp? 

Local pain, reflected pain, soreness to touch and suscepti- 
bility to heat. 

Describe minutely your treatment and manner of cap- 
ping a pulp. 

The rubber dam adjusted, the cavity is thoroughly cleansed, 
sterilized and dried. A dressing, composed of carbolic acid 
and oil of cloves, equal parts, combined with zinc oxide to 
make a paste, is placed over the pulp, care being taken not 
to produce any pressure. This is protected with a concave 
disk of pure tin. A filling, temporary in character, may then 
be inserted. 



OPERATIVE DENTISTRY. 23 

What classes of operations tend to induce a patholog- 
ical condition of the pulp and membranes of the teeth? 

The correction of irregularities, excessive grinding of teeth, 
rapid wedging, the preparation of cavities, and the placing 
of fillings in too close proximity to the pulp. 

What are pulp stones? Give treatment. 

Pulp stones are a formation of calcified matter within the 
pulp cavity. The treatment is devitalization and removal of 
the pulp. 

Give diagnosis of irritation from pulp stones. 

The pain is dull and reflected and the paroxysms are fre- 
quent. There is sensibility to cold and seldom pain on per- 
cussion. When the teeth are sound, the affected one can be 
determined by the thermal test. 

What causes the deposit over an exposed pulp? 

Irritation of the dentinal fibres which increases the func- 
tional activity of the pulp. 

When should a pulp be devitalized? 

When it has become the seat of irritation from pulp nod- 
ules, chronic inflammation or morbidity. In cases of trau- 
matic exposure, as in fractured teeth, and for the purpose of 
inserting certain forms of crowns. 

What are the risks attending the devitalization of pulps 
by arsenic? 

The destructive action on the adjoining tissues in case of 
its escape from the cavity. 

How should a pulp be devitalized by arsenic when de- 
cay exists below the soft tissues? 

The soft tissues are pressed out and protected with tem- 
porary stopping, after which arsenic may be applied. 

Give a safe and reliable way of applying arsenic for the 
devitalization of pulps. 

The rubber dam should be adjusted, the arsenic applied 



24 OPERATIVE DENTISTRY. 

and the cavity filled with oxyehlorid of zinc. When the 
rubber dam is removed, the surrounding tissues should be 
bathed with a solution of dialized iron. 

What are the symptoms of arsenic poisoning of the gum 
tissue? 

The gum is of a bluish- white color, there is pain about the 
affected parts, and the teeth are sore and loose in their sockets. 

Give a method of removing pulps other than by de- 
vitalization. 

The pulp is carefully exposed, a saturated solution of 
cocaine in chloroform applied, and the cavity filled with a 
piece of unvulcanized caoutchouc on which pressure is 
brought to bear with a large ball burnisher. In this man- 
ner the pulp can be anesthetized in a few minutes, after 
which it is removed in the usual way. 

Describe the diagnostic signs of a dead pulp in a tooth 
when there is no pulp exposure. 

There is no response to the application of excessive cold, 
especially that produced by an ethyl chlorid spray. There 
is also a marked opacity of the tooth. 

How would you diagnose a diseased pulp in an appar- 
ently sound tooth? 

Diseased pulps may be diagnosed by their altered response 
to the thermal test and by tapping. 

How should a pulp canal be prepared for filling? 

It should be well opened and thoroughly cleansed by means 
of instrumentation and sterilization. 

State a method of filling pulp canals. 

Oxyehlorid of zinc introduced upon strands of fiber asbes- 
tos; also chloro-percha introduced in the canal in which 
gutta-percha points are inserted. 



OPERATIVE DENTISTRY. 25 

Describe a method of filling a root canal having a large 
apical foramen. 

The canal is thoroughly dried, the walls are moistened with 
eucalyptus, a gutta-percha cone, approximating in size the 
foramen, is inserted and forced up until the patient flinches, 
after which the canal is filled in the usual manner. 

How should crooked buccal root canals be treated and 
filled? 

The canal should be opened by means of sulphuric acid 
and the Donaldson's canal-cleanser, after which they are 
syringed with a solution of chlorid of zinc, which is fol- 
lowed by blasts of warm air. The canal should be filled 
with chloro-percha containing hydronaphtol. 

Give the method of removing a pulp and filling the root 
canals in inferior molars with approximal cavities in distal 
surfaces. 

The cavity must be sufficiently enlarged to permit of direct 
access to the pulp-chamber. The pulp is removed with a 
barbed broach, the canals are well opened, sterilized and filled 
with gutta-percha points. 

Under what condition is immediate root=canal filling 
advisable. 

When the pulp has been extirpated en masse. 
What is mummification of the dental pulp? State under 
what condition such treatment would be advisable. 

It is the method by which the pulp is deprived of its 
moisture, or so changed as to be impervious to putrefactive 
agents. 

When the canals cannot be thoroughly cleansed and filled, 
this treatment is indicated. 

Describe a method of treating a perforated root where 
the gum has grown through the opening, filling the pulp 
chamber and resembling a fungoid pulp. 

The growth should be removed by means of a finely-pointed 



26 OPERATIVE DENTISTRY. 

lance, the tissue having been previously anesthetized with 
ethyl chlorid. The bleeding can be controlled by means of 
applications of tannin. Pellets of cotton, saturated with 
tincture of iodine, are packed against the tissue, and the 
canal and cavity filled with cotton dipped in sandarac var- 
nish. This treatment is continued each day, or until the 
margins of the perforation are plainly seen. The canal 
should then be cleansed, sterilized, dried and filled with 
gutta-percha to about half its depth. A piece of platinum 
foil, No. 60, is then cut, slightly larger than the perforation, 
dipped in chloro-percha and placed against the opening. 
The remainder of the canal is filled with zinc phosphate. 

Give the treatment of inflamed periosteum resulting 
from the filling of pulp canals. 

It consists in the application of counter-irritants to the 
gums. 

Why do pulpless teeth loose their natural hue? 

It is because of the death of the protoplasmic processes 
contained in the dentinal tubules — the result of the removal 
of the main central organ. 

What causes the pink color sometimes found in teeth? 

It is the absorption of the hemoglobin by the tubular 
structure of the dentin, resulting from the breaking down 
of the corpuscular elements in the blood. 

What causes pulpless teeth to blacken? 

The absorption of the products of decomposition of the 
proteid elements of the pulp by the dentinal tubules; also 
the effect of metallic salts which are used in dental thera- 
peutic treatment. 

Give a method for bleaching teeth. 

Remove all extraneous matter, adjust the rubber dam and 
fill the upper third of the root with gutta-percha. Pyrozone 
(25 per cent, etherial solution of hydrogen dioxid) is applied 
to the remaining unfilled portion of the canal. It should be 



OPERATIVE DENTISTRY. 27 

introduced on small pledgets of cotton and inserted by means 
of a platinum canal-plugger. After each application the 
solution is evaporated by blasts of warm air from a hot-air 
syringe. This is continued until the desired effect is pro- 
duced. 

What diseases may arise from a putrescent pulp? 

Pericementitis and alveolar abscess. 
What causes pericementitis? 

Pericementitis is the result of inflammation of the pulp, 
irritation from a dead or decomposed pulp, the use of arsen- 
ious acid, salivary calculus, mercurial poisoning, malocclu- 
sion, excess of filling material, and caries extending beyond 
the margins of the gum. 

What characteristic pain results from a pathological 
condition of the peridental membrane? 

Dull continued pain, elongation of the affected tooth, with 
painful response to pressure. 

What are the distinguishing symptoms of pericemental 
and pulp pain? 

Pericemental pain is increased by pressure upon the 
affected tooth. Pulp pain responds to thermal variations. 

Give treatment of pericementitis. 

The pulp-chamber is opened to give vent to the incased 
gases, after which the canal is thoroughly reamed, cleansed 
and sterilized. A dressing of cotton saturated with campho- 
phenique is sealed in the canal and changed from time to 
time until all odor and pain has disappeared, when the tooth 
may be filled. When the tooth is too sore to permit of thor- 
ough instrumentation, counter-irritants are applied and qui- 
nine and ammonol administered in small doses. 

Describe the treatment of pericementitis when the root 
canal is permanently filled. 

The treatment consists in the application of counter- 



28 OPERATIVE DENTISTRY. 

irritants to the gum and in the administration of sedatives 
and a saline cathartic. Should this fail to give relief, then 
the gum is deeply scarified, the filling removed from the 
canal and the canal treated antiseptically. 

Give the diagnosis of pericemental abscess. State the 
treatment employed and medicaments used. 

The tooth is loose, elongated and sore, the gum swollen and 
inflamed. There is a feeling of relief when pressure is ap- 
plied. The treatment consists in applying counter-irritants 
to the gum and in gaining access to the abscess tract along 
the line of the root, in which is injected a 3 per cent, solu- 
tion of pyrozone followed by a 10 per cent, solution of chlorid 
of zinc. 

How should alveolar dental abscess be treated? 

The treatment of alveolar abscess consists in gaining free 
access to the diseased area, in opening, cleansing and steril- 
izing the canals. The abscess tract is then washed with a 
3 per cent, solution of pyrozone. If the abscess is without 
a fistula, an effort is made to evacuate the pus through the 
canal. Should this fail, an entrance must be gained through 
the gums, which is accomplished with a pointed bistoury or 
engine-drill. If the abscess has a fistula, it is sometimes 
necessary to enlarge it in order to allow a free escape of the 
pus. The entire tract is then washed with a 3 per cent, solu- 
tion of pyrozone and the canal treated with cotton dressings 
of campho-phenique or Black's 1, 2, 3 mixture. This is 
repeated at intervals of two or three days until the abscess 
cavity is healed, when the canals and the cavity can be filled. 
In chronic cases, where the disease fails to respond to the 
medicinal treatment, amputation of the root is indicated. 

What is a blind abscess? 

It is a chronic abscess without a fistula. 

What is the treatment of an alveolar abscess without 



OPERATIVE DENTISTRY. 29 

fistula when the roots have been properly treated and 
filled? 

An opening is made through the gum and the alveolar 
process, and the pus evacuated. The abscess-tract is then 
washed out with a solution of 3 per cent, pyrozone followed 
by an injection of a 10 per cent, solution of chlorid of zinc. 

What is root amputation? Describe the operation. 

It is the excision of the apex of the root, The operation 
consists, first, in rendering the parts aseptic. A vertical in- 
cision is then made, exposing the process. "With a large 
rose-head bur, sufficient of the process is removed to permit 
of working on the root. The opening thus made is packed 
with cotton saturated with phenol sodique until the bleeding 
ceases. The portion of the root to be removed is then exposed 
and with a small, rapidly-revolving fissure-bur, amputated. 
The excised portion is taken out by means of a small exca- 
vator. The edges of the remaining root are smoothed with 
a sharp scaler. The cavity is syringed with mercuric chlorid, 
1-1000, and packed with iodoform gauze. This dressing is 
renewed after a few days. The patient is instructed to use 
frequent washes of phenol sodique. 

Describe the process of replanting teeth and state pre= 
cautions necessary. 

The mouth is thoroughly sterilized and the tooth extracted. 
It is immediately placed in a warm solution of mercuric 
chlorid, 1 to 1,000. The socket from which the tooth has 
been removed is syringed with pyrozone and packed with 
cotton saturated with campho-phenique. The tooth is dried, 
and if the root has been denuded of the pericementum, that 
portion is cut away and the end smoothed. The canal is 
opened, sterilized and filled with gutta-percha; the tooth is 
then returned to the antiseptic solution. The cotton is re- 
moved from the socket, which is again washed with pyrozone 
and the tooth then returned to position. It is attached to 



30 OPERATIVE DENTISTRY. 

the adjoining teeth with ligatures and held firm for a week 
or ten days. 

Describe the operation of implanting and the precau- 
tions necessary. 

The operation of implanting consists in making an incision 
through the gum tissue. By means of the trephine or a 
reamer, a socket is drilled into the maxillary bone. During 
the process of preparing the socket, the tooth to be implanted 
is frequently inserted until the proper adjustment has been 
secured. When this is obtained, the tooth and the contig- 
uous parts should be placed in aseptic condition. The tooth 
is then inserted and held firm by means of ligatures until 
nature has deposited a calcific matrix around it. 

The precautions necessary are thorough asepsis and the 
avoidance of dangerous anesthetics. Care must be taken in 
preparing the sockets for the superior central incisors be- 
cause of the proximity of the anterior palatal nerve and vein. 
With the lateral incisors care must be taken to preserve the 
labial plate of the alveolus. The bicuspid and molar re- 
gion present the danger of perforation of the floor of the 
maxillary sinus. 

In the lower jaw the precaution necessary is to avoid the 
vessels passing through the mental foramen. 

Give diagnosis of exostosis. State the cause and treat- 
ment. 

There is more or less pain in and about the region of the 
deposit. Not infrequently the pain is reflected to parts quite 
remote from the seat of the trouble. In many cases a pro- 
nounced swelling can be felt on the alveolus over the affected 
tooth. 

The cause of exostosis is irritation of the peridental mem- 
brane. Treatment: In the early stages the application of 
iodine may retard its progress. When the disease is well 
advanced, extraction is indicated. 

Give method of extracting a tooth with the root so en- 



OPERATIVE DENTISTRY. 31 

larged by exostosis that its removal through the socket 
must result in fracture of the jaw. 

A portion of the alveolar wall over the affected organ is 
removed. This will permit of the tooth being lifted out in 
the usual manner. 

When is the extraction of teeth indicated? 

When teeth are the seat of an incurable disease, or when 
they are associated with diseases of the maxillary sinus or the 
nasal chamber; to prevent or correct irregularities, in case 
of excessive looseness of the teeth through loss of the sur- 
rounding tissues. 

When teeth are retarded in their eruption, thus causing 
considerable pain. In the preparation of the mouth for an 
artificial denture it is sometimes expedient to remove one or 
two remaining teeth. 

Mention some of the conditions which necessitate 
special precautions in extracting teeth. 

Crowded teeth, where the forceps cannot be properly ad- 
justed; crowns with frail walls, and impacted teeth. 

Give method of extracting the roots of an inferior third 
molar when the crown is broken off and the gums are 
swollen. 

An incision is made in the gum buccally and lingually so 
as to permit getting a firm hold of the root with the forceps. 
Then by an upward and backward movement the root is re- 
moved. 

Describe the operation of extracting incisors, cuspids, 
bicuspids and molars. 

All teeth with single and rounded roots are removed by a 
rotary movement. Those with flattened single roots by an 
in-and-out movement. The superior molars are removed by 
an in-and-out movement ; the inferior molars by an out-and-in 
movement. 



32 OPERATIVE DENTISTRY. 

At what age is it best to extract the first permanent 
molar? Give reason. 

When this molar cannot be permanently preserved, it 
should be retained up to a period between the tenth and 
twelfth year, or until the second molar is about to erupt. If 
lost before that period, it will cause an irregularity. If later, 
the space it has occupied is never completely closed and the 
adjacent teeth will incline towards the vacant space, thus an 
impairment of the occlusion results. 

What accidents are liable to happen during the extrac= 
tion of teeth? 

The breaking of the tooth or root, the fracture and removal 
of the alveolar plate, the breaking of the tuberosity, the 
fracture of the lower maxilla and excessive hemorrhage. 

Describe the treatment of excessive hemorrhage follow- 
ing tooth extraction. 

The administration of ergot in small doses ; packing a rope 
of cotton saturated with a solution of tannic acid, adrenal or 
hydrogen dioxid (25 per cent,), into the alveolus, and a com- 
press made of modeling compound. 

What anatomic changes are produced by the loss of the 
teeth? 

Resorption of the alveolar walls, which results in altered 
facial expression. 

When is the extraction of deciduous teeth indicated? 

When they are badly diseased, affecting the general health j 
when the permanent teeth are about to erupt. 

What (if any) possible evils may arise from premature 
extraction of temporary teeth? 

Impaction and irregularity of the permanent teeth. 

In doubtful cases how would you distinguish a tem= 
porary from a permanent tooth? 

By its size, which is relatively smaller ; by the color, which 



OPERATIVE DENTISTRY. 33 

is whiter, and by a marked depression on the neck at the 
union of the enamel and the cementum. 

Under what conditions in deciduous dentition is lancing 
of the gums indicated? Explain. 

Fretfulness, inability to sleep and general derangement, 
and when the gum tissue is inflamed. 

The operation relieves the resistance which the gum offers 
to the erupting teeth and allows them free access. 

Describe a method of treating decay in deciduous teeth. 

The decay should be removed, care being taken not to en- 
croach upon the pulp, the cavity sterilized or coated with a 
solution of nitrate of silver and filled with one of the plastics. 

Give method of treating and filling approximal cavities 
in permanent teeth of children when these teeth are de= 
ticient in lime salts. 

The decay should be thoroughly removed, the cavity steril- 
ized and filled with gutta-percha. 

How should an abscessed deciduous tooth be treated? 

The pulp-chamber should be opened and the pus evac- 
uated either through the canals or by means of a bistoury 
passed into the swelling. The canals should then be steril- 
ized with pyrozone followed by an application of oil of cloves. 
Several treatments are necessary to obtain thorough asepsis, 
after which the canals are filled with strands of cotton satur- 
ated with oil of cassia, the cavity with gutta-percha. 

Give etiology and treatment of green stain on children's 
teeth; mention the medicaments used. 

It is a growth of fungi (leptothrix) upon the surface of 
the teeth. It is removed with pulverized pumice and tinc- 
ture of iodine applied on a point of orange wood, after which 
the teeth should be thoroughly polished. 
3 



34 OPERATIVE DENTISTRY. 

What injury may result from green stain on children's 
teeth? 

Erosion of the enamel, in consequence of which decay takes 
place. 

What are the best materials for filling deciduous teeth? 

Gutta-percha, oxyphosphate cement and amalgam. 

Give the treatment in case of pulp exposure attended 
with pain in a deciduous tooth. 

The treatment consists in allaying the pain with applica- 
tions of carbolic acid, after which the pulp should be devital- 
ized and removed. 

Give the treatment of exposed pulp in deciduous teeth 
of a child six years of age. Give reasons. 

The treatment indicated is devitalization and removal of 
the pulp. This is more satisfactory than conservative treat- 
ment, because of the difficulty of properly capping an ex- 
posed pulp in a deciduous tooth. 

How should the pulps of deciduous teeth be devitalized? 

By means of "devitalizing fiber," which should be sealed 
in the cavity and allowed to remain for twenty-four hours. 
Carbolic acid, iodine and aqua ammonia are also effective. 

How should the pulp canals of deciduous teeth be filled? 

With a paste of iodoform and glycerol. 

Give the treatment of a child ten years old whose cen- 
tral incisors are broken, so that the pulps are exposed. 

Powdered cocaine crystals moistened with distilled water 
are applied to the exposed surface of the pulp ; over this 
is placed a small piece of punk to which pressure is applied 
and continued until the pulp is anesthetized. It is then 
removed, the canals are filled with gutta-percha and the 
external opening with gold. At the fifteenth year the teeth 
may be restored to their normal shape by adjusting porce- 
lain tips. 



OPERATIVE DENTISTRY. 35 

How should a first permanent molar with inflamed pulp 
be treated in a child seven years of age? 

When the pulp in a first permanent molar has become in- 
flamed, the inflammation should be allayed by applications 
of eugenol and the pulp capped. If pain has existed period- 
ically for longer than a week's time, the pulp should be 
either devitalized or mummified. 

It is, however, highly questionable that at seven years of 
age the first permanent molar would have an inflamed pulp. 

Mention treatment of defective rough condition of sulci 
in children's teeth before softening occurs. 

The fissures should be treated by applications of a 25 per 
cent, solution of nitrate of silver. 

Give directions for the general care of the mouth and 
teeth of children. 

Directions should be given for the proper use of the brush, 
dental floss and a suitable tooth-powder. The teeth should 
be cleansed after each meal and frequent examinations ad- 
vised, at which time the surfaces of the teeth should be thor- 
oughly polished. 

What is dental orthopedia? 

It is the correction of dento-facial deformities by means 
of regulating appliances. 

What are the principal causes of irregularities in teeth? 

The causes are hereditary, constitutional, and acquired. 
Mention some of the causes of acquired irregularities. 

The premature loss of deciduous teeth, the too long reten- 
tion of deciduous teeth, early loss of permanent teeth, thumb- 
sucking, and delayed eruption of permanent teeth. 

What accidents may happen during the correction of 
dental irregularities? 

Death of the pulp, rupture of the pericementum, injury to 
the enamel, and enlargement of the alveoli. 



36 OPERATIVE DENTISTRY. 

Name two typical cases of acquired irregularity. De- 
scribe your treatment. 

1. The permanent cuspids standing outside of the arch. 

2. Excessive protrusion of the superior incisor teeth. 
Treatment for case 1 : If space is needed and expansion 

of the arch is contra-indicated, the first bicuspids must be 
extracted. This is frequently sufficient to allow the cuspids 
to assume their natural position. When an appliance is in- 
dicated, the cuspids and molar teeth are banded and small 
hooks soldered to each on the labial and palatine surface. 
To these hooks rubber bands or linen ligatures are attached 
and the teeth drawn in position. 

Treatment for case 2 : If space is needed, the first bicus- 
pids are extracted and the cuspids drawn back by means 
of jackscrews. The anterior teeth are drawn back by means 
of rubber bands attached to hooks soldered to molar bands. 
Notched bands on the central incisors will keep the rubber 
from sliding towards the gum. When the teeth are moved 
to their position, they should be held by means of a retainer, 
consisting of a labial bow attached to anchor-bands placed 
on the second bicuspids. 

How can the upper arch be expanded? 

By means of the coffin-split plate. 

How would you locate an unerupted tooth? 

By means of the X-Rays a radiograph of the parts can be 
taken; this will show the exact position of the tooth. 

How may an unerupted cuspid tooth be drawn into 
position? 

The crown of the tooth is exposed by making an incision 
through the gum. A small hole is drilled in the tooth in 
which a screw is secured. To this is attached a rubber band, 
fastened to a bar extending from the lateral incisor to the 
bicuspid. By this means the tooth can be drawn to its proper 
position. 



OPERATIVE DENTISTRY. 37 

State a method of reducing an extruding lateral incisor. 

A band is adjusted to the central incisor and one to the 
cuspid. To these bands bars are soldered, one on the labial 
and one on the palatal surface. A rubber band is stretched 
from the palatal to the lingual bar and over the cutting edge 
of the extruded tooth. By this means it can be forced in 
position. 

State the importance of removing deposits from the 
crowns and necks of teeth. 

Deposits on the crowns and necks of the teeth will cause, 
if allowed to remain, inflammatory disturbance of the gums 
and the contiguous tissues. 

Describe methods of removing these deposits and give 
the subsequent treatment. 

The deposits are removed by means of scalers of various 
sizes and forms. The instrument should be inserted beneath 
the frc" _argin of the gum and drawn towards the occlusal 
aspect. The surfaces thus scraped and the gingival borders 
of the gums are treated with a solution of hydronaphtol and 
alcohol. The teeth should then be thoroughly polished. 

Differentiate salivary calculus and sanguinary calculus. 

Salivary calculus is deposited from the saliva upon the 
exposed surfaces of the teeth. 

Sanguinary calculus is a deposit upon the roots of the 
teeth. It is precipitated from the liquor sanguinis of the 
blood. 

Differentiate pyorrhea alveolaris and salivary calculus. 
Give the cause, prognosis and treatment of each. 

Pyorrhea alveolaris is a flowing of pus from the alveoli, 
attended with more or less destruction of the alveolar process 
and the adjacent tissues. The exciting causes are a subgin- 
gival deposit of calculi. The prognosis is favorable, except 
when the disease has become chronic and is in part due to 
constitutional tendencies. 



38 OPERATIVE DENTISTRY. 

The treatment consists in a thorough scaling of the teeth 
and syringing with a 3 per cent, solution of pyrozone. The 
pockets are then saturated with trichloracetic acid, after 
which they are treated with tincture of iodine followed with 
a solution of hydronaphtol and alcohol. The teeth, if loose, 
should be ligatured and mal-occlusion corrected. 

Salivary calculus is a deposit from the saliva upon the 
exposed surfaces of the teeth. The treatment consists in its 
removal by means of scalers and in polishing of the sur- 
faces of the teeth. 

Pyorrhea alveolaris is sometimes the local manifesta- 
tion of which nutritional disorders? 

Gout, diabetes, chronic rheumatism, scurvy, and anaemia. 

In the treatment of pyorrhea alveolaris what attention 
should be given to the patient's diet? 

Albuminous food should be prohibited and the free use of 
alkaline waters advised. 

State the uses of nitrate of silver in operative dentistry. 

It is used as a disinfectant, as an obtundant for hyper- 
sensitive dentin on exposed surfaces, as a treatment for 
caries in deciduous teeth ; also in ulcerated conditions of the 
mucous membrane of the mouth. 

Why does the application of nitrate of silver arrest de- 
cay in teeth? 

It forms, with the dentinal substance, an impenetrable albu- 
minate of silver which has high antiseptic property. 

What are the uses of sulphuric acid in operative den- 
tistry? 

It is employed to open minute root canals, in the treatment 
of carious bone, in the treatment of pyorrhea alveolaris as a 
solvent for concretions upon the root. 

What instruments should receive special attention as 



OPERATIVE DENTISTRY. 39 

regards sterilizing? What means should be employed to 
effect thorough sterilization? 

All dental instruments should be sterilized. Those more 
apt to be a source of infection are broaches, drills and all 
instruments used in pulp-canal treatment. 

Broaches and drills should be freed from all adhering 
matter and with the other instruments placed in Schering's 
formalin sterilizer. 

Describe the method of examining the teeth of patients 
and mention the instruments used. 

The instruments used are explorers, mirrors, floss silk and 
wedges. Beginning at the median line, the surfaces of each 
tooth are carefully examined with the mirror and explorer. 
The condition of the sulci and approximal surfaces is care- 
fully noted. The lines of apparent contact are tested with 
the mirror for evidence of discoloration indicating the pres- 
ence of decay. 

Describe method of cleansing the teeth. 

The mouth should first be cleansed with a 10 per cent, 
solution of hydrogen dioxide. With properly shaped scalers 
all deposits about the teeth should be thoroughly removed. 
The surface of each tooth is then polished with rubber pol- 
ishing-cups and finely-powdered pumice; this is followed 
with a brush and suitable tooth-paste. The teeth and con- 
tiguous parts should be sprayed with an antiseptic solution. 

Mention the benefits derived from the use of electricity 
in dental practice. 

Cataphoresis, drying and sterilizing root canals, trans- 
illumination of the teeth and contiguous parts by the electric 
mouth-lamp. Fusing porcelain and furnishing motor-power 
for the dental engine, lathe, etc. 

Give treatment of a lower third molar having many 
grooves or sulci radiating from a common center when 



40 OPERATIVE DENTISTRY. 

caries appears on the occlusal surface or the buccal sur= 
face. 

If the buccal surface is not involved, the cavity on the 
occlusal surface and the radiating sulci should be fully 
opened and cleared of decay and discoloration. If the buc- 
cal surface is involved and the decay extends so near to the 
occlusal surface that the occluso-buccal wall is weakened, the 
two cavities should be united. 

Describe the technic of making and inserting a porce- 
lain inlay in a disto=palatal cavity of an incisor. 

The cavity is prepared in the usual manner. An impres- 
sion is taken with dental "lac" and a cast made of either 
Spence metal or oxyphosphate cement. From this a matrix 
is made of platinum one one-thousandth of on inch in thick- 
ness. The porcelain body is mixed with distilled water and 
placed in the matrix with a fine-pointed spatula. The mois- 
ture is extracted by means of blotting-paper. The inlay is 
then carefully dried by holding it at the opening of the 
muffle, into which it is gradually introduced and biscuited. 
It is then allowed to cool, placed in the cavity and the edges 
reburnished. 

Porcelain body is again added, carrying it flush with the 
cavity margins, after which it is dried and baked until a 
gloss appears. The platinum is then removed, the porcelain 
grooved with a fine disk and the inlay is ready to be in- 
serted. This is accomplished by means of oxyphosphate 
cement, which should be mixed to the consistency of cream. 
The cavity is partially filled with the cement and the inlay 
forced into it, holding it firmly in place until the cement 
hardens. The tooth and contiguous parts should be pro- 
tected from moisture by means of small napkins. 

Describe the condition of the teeth and the appearance 
of the roof of the mouth in a case of chronic hypertrophy 
in the nasopharynx. 

The central incisors protrude, one overlapping the other, 



OPERATIVE DENTISTRY. 41 

their mesial surfaces resting in contact near their incisive 
edge. The lateral incisors assume a position posterior to the 
centrals. The roof of the mouth is high and the arch narrow 
and contracted. 

What do you understand by the term prognathism? 

An abnormal protrusion of the jaws. 

What results are liable to follow the premature extrac- 
tion of the deciduous teeth? (a) Incisors, (b) cuspids, 
(c) molars. 

(a) The permanent teeth are liable to erupt in an irreg- 
ular position; the central incisor taking the position of the 
deciduous central and lateral, thus forcing the permanent 
lateral to rest inside the circle of the arch. 

(&) The premature loss of the deciduous cuspid allows the 
erupting lateral and bicuspid to encroach on the space that 
should be preserved for the permanent cuspid, causing it to 
erupt in an abnormal position. 

(c) The first permanent molar on that side moves forward 
in the line of the arch, assuming the position that should 
have been preserved for the second bicuspid. 

Mention a preferable method of annealing gold=foiI 
while introducing a filling. Give reasons. 

By means of the electric annealing tray. The gold can be 
heated to any desired degree and with a uniformity not 
attainable by other methods. 

What is the operation " extension for prevention "? 
How and why is it performed? 

It is the removal of the enamel margins by cutting from 
a point of greater liability to a point of lesser liability to 
recurrence of caries. 

It is performed by means of chisels, excavators and burs ; 
it is done to prevent a recurrence of caries. 



PROSTHETIC DENTISTRY. 



What constitutes the basis of Prosthetic Dentistry? 

A thorough, knowledge of the science and art of dentistry, 
together with a high order of manipulative skill. 

How should the mouth be prepared to receive a full arti- 
ficial denture? 

Diseased teeth and roots should be extracted and the mouth 
placed in a healthy condition. 

In preparing the lower jaw for artificial teeth, how 
many, if any, natural teeth should be left in the mouth? 

All teeth in a healthy condition and not interfering with 
the utility and with the appearance of a denture should be 
left in the mouth. 

When an impression is required for an artificial den- 
ture of any kind, what conditions of the mouth should be 
considered? 

The size and shape of the jaws, the palate, whether deep 
or shallow, hard or soft; the alveolar ridge, whether hard or 
soft, and the relative difference between the hard and soft 
parts of the mouth ; if there are remaining teeth, their con- 
dition, whether they are loose or not, or their position such as 
would require special attention in removing the impression. 

Mention the various materials used for taking im- 
pressions. 

Plaster of Paris, modeling composition, gutta-percha and 
beeswax. 

What are the requisites for an impression material? 

Plasticity, the property of hardening within a short time 

(43) 



44 PROSTHETIC DENTISTRY. 

while in the mouth and the absence of expansion and con- 
traction, except in a moderate degree. 

What is plaster of Paris chemically? How is it pre= 
pared for dental purposes? 

Natural sulphate of calcium less two-thirds of its water of 
constitution. By roasting and grinding gypsum. 

Describe your method of taking a full upper impression 
in plaster of Paris. 

A tray suited to the case is selected and a piece of softened 
beeswax placed across the posterior palatal portion. The 
patient should sit erect with the head slightly forward, the 
operator standing at the right of the chair. The cup filled 
level with the mixed plaster, into which a few grains of salt 
have been sprinkled, is introduced into the mouth, and 
pressed up, with the rear in advance of the front. When the 
parts are completely embedded, pressure should be brought 
on the lips and cheeks so as to force the plaster well up over 
the outside ridge. The tray should be held firm until the 
plaster will fracture with a clear break. The cheeks are now 
distended with the fingers, the tray is depressed in the back 
and with a slight forward and downward movement it is re- 
moved. Should the impression fracture, the parts are care- 
fully taken away, adjusted to place and held with wax. 

What is the best method of taking a partial difficult im- 
pression? 

An impression tray of proper size and shape is oiled and 
filled with plaster. It is introduced into the mouth and 
forced well up. When the plaster is hardened, the tray is 
detached from the impression and removed from the mouth. 
With a blunt instrument the sides and front of the impres- 
sion are broken away, after which the portion covering the 
palatal surface is taken out. The pieces are then placed in 
the tray and joined with wax. 

What are the qualities of a good impression? Give test. 

A good impression must have fulness, smoothness and 



PROSTHETIC DENTISTRY. 45 

sharpness. It should cover a little more surface than the 
finished base-plate; it should reproduce exactly the finest 
lines and be as smooth as the mucous membrane. 

The best test of a good impression is the degree of resist- 
ance offered to its removal. 

How may nausea be prevented in a particularly sensi= 
tive mouth while an impression is being secured? 

By gargling the throat with camphor water just before 
taking the impression, or by painting the parts with a one 
per cent, solution of cocaine. 

State the two essential requirements for the production 
of a perfectly=fitting denture. 

An accurate impression and model. 

How soon after a plaster impression is taken should the 
plaster be poured for the model? Give reasons for your 
answer. 

The model should be run within a few hours from the time 
the impression has been taken, or before the latter becomes 
too dry. Thus expansion or porosity, as well as crystalliza- 
tion of the salt on the surface of the cast is prevented. 

How may plaster teeth on models be strengthened to 
prevent fracture? 

By forcing pins into the teeth cavities of the impression 
before the model is poured. 

How should a plaster model be treated when a portion 
of the ridge is soft and the center of the mouth hard? 

The cast should be scraped at the portion corresponding 
to the soft portion of the ridge and the center should be 
relieved by a strip of lead or tin a thirty-second of an inch 
in thickness. 

What properties are requisite for a good base plate? 

It should possess the property of malleability or of being 
rendered soft when subjected to heat, while at the same time 
it should be unaffected by the temperature of the mouth. 



46 PROSTHETIC DEXTISTRY. 

Describe the method of obtaining a correct bite for a 
full upper and lower set. 

To the upper and lower base plates, which have been 
accurately fitted to the models, a rim of softened beeswax is 
attached, sufficient to secure the fulness and length of the 
teeth to be inserted. The rims are neatly trimmed and the 
trial-plates placed in the mouth. After the proper length, 
contour and correct apposition of the rims have been ob- 
tained, the patient is directed to swallow and bite. This is 
repeated several times to assure accuracy. The median line 
is then marked, the rims are united with a hot spatula and 
the two articulating models removed together. 

What relation should the artificial teeth bear to the 
alveolar ridge? 

The long axis of the teeth should be in line with the ver- 
tical axis of the alveolar ridge. 

What general principles should be observed in arrang- 
ing artificial teeth for an edentulous mouth? 

The teeth should be arranged so as to restore the expres- 
sion of the mouth and face. 

They should occlude properly and be placed as near the 
center of the ridge as possible. 

What relation in regard to length should (a) the upper 
teeth bear to the upper lip, (b) the lower teeth bear to 
the lower lip? 

(a) The superior teeth should extend below the upper lip 
sufficient to show the tips when the mouth is opened without 
raising the lips. 

(6) The lower teeth should be a few lines shorter than the 
lower lip, or so that they are not visible when the mouth is 
in a passive state. 

In Prosthetic Dentistry what is meant by " re=posing 
the features." 

By the term "re-posing the features" we include every- 



PROSTHETIC DENTISTRY. 47 

thing necessary to bring each and all of the visible parts of 
the face and mouth into harmony of relation to each other. 
(Warren: "Dental Prosthesis.") 

In full dentures, are the upper or the lower teeth first 
arranged on the model? Give the general arrangement. 

The anterior inferior teeth are generally arranged first. 
All the teeth except the inferior incisors and the superior 
second molars should have two antagonists in articulating. 

The anterior superior teeth, beginning with the central in- 
cisors, should incline slightly towards the median line, which 
should divide the space between the centrals. The lower 
teeth should stand nearly straight, the cusps of the bicuspids 
and molars occluding inside the cusps of the superior bicus- 
pids and molars. The occlusion should be even on both sides. 

The relative length of the teeth is governed by the articu- 
lating models. 

In articulating a full denture, what teeth should bear 
the greatest pressure of the bite? 

The bicuspids and first molars. 

State the value of the study of temperaments in the 
practice of Prosthetic Dentistry. 

It enables the dentist to select teeth the size, shape and 
color of which conforms to nature's type in the physical 
organization. 

Describe the size, form and color for (a) a bilious, (b) a 
sanguinous, (c) a nervous, (d) a lymphatic temperament. 

(a) Large, rather long in proportion to breadth, angular; 
color, deep yellow. 

(6) "Well proportioned, length slightly predominating over 
width; color, cream-yellow. 

(c) Length greater than breadth; fine, long cutting edges; 
color, pearl-blue or gray, inclined to translucency. 

(d) Large, breadth greater than length, poorly shaped; 
color, opaque and pallid. 



48 PROSTHETIC DENTISTRY. 

Explain how an entire upper denture is retained in 
position. 

By atmospheric pressure or adaptation. 

What is the value of relief spaces as compared with 
vacuum chambers in full upper dentures? 

By relief spaces maximum adaptation is secured and pos- 
sible irritation to the tissues avoided. 

What is the Cleaveland vacuum=cavity? 

It is a soldered vacuum-cavity, the cap being a little larger 
than the opening cut in the plate. 

What relation should the vacuum=chamber bear to the 
center of gravity? * 

It should be placed at the center of gravity. 

How would you find the center of gravity of the palatal 
vault on a model of an edentulous upper jaw?* 

The center of gravity can be found by drawing lines from 
the centers of both condyles to the junction of the first and 
second bicuspids on each side. At the point on the median 
line where the lines intersect will be the center of gravity. 

What nerves may suffer from the sharp anterior edge 
of an improperly placed vacuum=chamber? 

The naso-palatine nerves. 

What muscles have a tendency to displace (a) an upper 
denture, (b) a lower denture? 

(&) Buccinator. 

(6) Mylo-hyoid and geniohyoglossus. 

How may the pressure of an upper artificial denture be 
equalized when portions of the mouth are very hard and 
portions very soft? 

By relieving the impression at such places as correspond 

*" Centre of gravity" as applied to an upper denture seems a meaningless 
expression. The vacuum-cavity should be situated at about the centre of the 
area covered by the plate. 



TTA 



PROSTHETIC DENTISTRY. 49 

to the hard portions of the mouth, and by scraping the cast 
at such points as correspond to the soft portions of the mouth. 

How may a plate be prevented from rocking in a mouth 
with a hard palatal ridge? 

By relieving the entire central portion of the plate. 

Mention the three principal ingredients used in manu- 
facturing teeth and state which one gives the translucency 
and lifelike appearance to the teeth. 

Kaolin, feldspar and silex. The feldspar is used to pro- 
duce the enamel and to give it translucency. 

What metal is used as a coloring agent to produce the 
grayish=blue tint of the enamel of artificial teeth? 

Platinum. 

What is Purple of Cassius and for what is it used in 
porcelain? 

It is a mixed oxide of gold and tin, and is used to produce 
the gum color in porcelain. 

What color is produced by titanium in porcelain enamel? 

Yellow. 

Describe the difference between long=bite teeth and 
short=bite teeth. Mention cases where each would be 
appropriate. 

In long-bite teeth the distance between the cutting edge 
and the pin-guard (the ridge or shoulder of porcelain extend- 
ing across the lingual surface of the tooth, which indicates 
the extent of the lap of the upper incisors over the lower) is 
greater than that in the short-bite teeth, where the ridge is 
closer to the cutting edge. 

Short-bite teeth are indicated where there is a long ridge 
and a short lip; long-bite teeth, where the alveolar ridge is 
shorthand the lip long. Short-bite teeth are also indicated 
where there is but little overlap of the antagonizing teeth, 
and long-bite teeth where the overlap is more marked. 
4 



50 PROSTHETIC DENTISTRY, 

What are the relative merits of plain teeth and gum 
sections? State where each should be used. 

Plain teeth can be more artistically arranged than gum 
sections. They should be employed only where the teeth are 
to rest directly upon the natural gum, or where the length 
of the lip is sufficient to conceal the artificial rubber gum. 

Where the lip is short and the gum is more or less exposed 
while laughing or talking, or where there has been consider- 
able resorption of the ridge and greater fulness is required, 
better results are obtained with gum sections. 

Where can pinless or diatoric teeth be advantageously 
used? 

In cases which do not require grinding of the porcelain. 
In cases where they are not required to set close to the alveo- 
lar ridge. If ground, the undercuts are weakened, and if 
set close to the ridge, their shape does not allow of sufficient 
vulcanite to make a strong denture. 

How soon after extraction of the teeth should full tem- 
porary dentures be inserted? permanent dentures? 

Temporary dentures may be inserted immediately or soon 
after the extraction of the teeth; permanent dentures after 
complete resorption has taken place, which usually requires 
from six to twelve months. 

What are the advantages of countersunk=pin teeth? 

Their close conformity in contour to the natural organs 
makes them more acceptable to the tongue, renders articula- 
tion easier and more distinct, and, when properly mounted, 
they present a naturalness of appearance seldom obtained 
with the other varieties. 

Why is a temporary denture desirable? 

To preserve the natural expression of the lips as well as 
the normal position of the lower maxilla. 



PROSTHETIC DENTISTRY. 51 

Does absorption of the alveolar process advance more 
rapidly with or without a plate? 

With a plate. 

What causes dark joints in gum teeth? How can this 
be prevented? 

The entrance of rubber or of foreign substances between 
the joints. 

It can be prevented by grinding the joints so that their 
surfaces come in perfect contact, thus avoiding a V-shaped 
space, and by the use of a very hard-setting plaster for flask- 
ing. Soft cement placed over the joints will also prevent the 
entrance of foreign substances. 

State what causes gum sections to break in the flask? 

The presence of too much rubber and excessive force in 
screwing down the flask. 

Name the various materials used as a base for artificial 
dentures. 

Rubber, aluminum, silver, gold, platinum, celluloid, contin- 
uous gum and porcelain. 

What base for an artificial denture do you consider 
hygienically the best and why? 

Porcelain or continuous gum. It is hygienically the best 
because of the absence of porosity and of spaces for the 
accumulation of food. 

Where and how is crude rubber obtained? 

Crude rubber or caoutchouc is a milky exudate obtained 
by tapping the Siphonia elastica, a South American tree. 

What is the substance known as vulcanite? 

Caoutchouc and sulphur submitted to the process of vul- 
canization. 

Name the principal solvents of rubber. 

Ether, chloroform, kerosene, and the essential oils. 



52 PROSTHETIC DENTISTRY. 

What is the coloring pigment in red vulcanite, black 
vulcanite, pink vulcanite? 

The coloring pigment in red vulcanite is vermilion; in 
black vulcanite, ivory-black; in pink vulcanite, white oxide 
of zinc and vermilion. 

How may vulcanite be bleached? 

By placing it in absolute alcohol and subjecting it to the 
rays of the sun. 

State the amount of caoutchouc and of sulphur used in 
making vulcanizable rubber suitable for dental plates. 

Caoutchouc, 48 parts ; sulphur, 24 parts. 

What causes the tissues to inflame under a rubber 
plate? 

The generation of heat due to the rubber being a negative 
electric and the irritating action of the coloring matter in 
the red rubber — mercuric sulphide (vermilion). 

State the reasons for using black, red and pink rubber. 

When red rubber irritates the tissues, black rubber should 
be used. Pink rubber is employed in the anterior part of 
the mouth, because it approximates the color of the gums. 

What is weighted rubber, and where is its use indicated? 

Rubber in which tin filings are incorporated. It is em- 
ployed in lower dentures, to be used in mouths where there 
is little or no ridge and where weight is essential to the re- 
tention of the plate. 

At what degree of heat and how long should a rubber 
denture be vulcanized in order that the best results may 
be obtained? 

It should be vulcanized for fifty-five minutes at a temper- 
ature of 320° F. 

What part of an upper denture has the greatest influ = 
ence on the expression of the face? 

The anterior part. 



PROSTHETIC DENTISTRY. 53 

What are plumpers? Where placed? State their use. 

Plumpers are rolls of vulcanite placed on the labial and 
buccal rim of the denture. They serve to restore the features 
of the face. 

What is the guide for the amount of rubber to be used 
in packing a case? 

The wax from the model plate is placed in Starr's meas- 
uring-glass which is half filled with water, noting the height 
to which the water rises. The wax is then removed and 
sufficient rubber is put into the glass to raise the water to 
the same level or a little higher. 

Describe the method of constructing an artificial den= 
ture on a vulcanite base. 

An impression of the mouth is taken in plaster of Paris, 
from which is secured a plaster model. If an air-chamber is 
required, it is cut from sheet tin and secured in position on 
the model. A base plate of modeling compound is made to 
conform to the model. To this is attached the wax guide or 
rim, which is trimmed to the desired width, fulness and con- 
tour. This is placed in the mouth and the bite secured, after 
which it is returned to the model and, with the antagonizing 
model, is placed in the articulator. The teeth are arranged 
and waxed on this temporary plate, which is carved and 
trimmed just as the finished plate is desired to be. The 
model, with the plate, is removed from the articulator, the 
plaster trimmed, moistened and invested in the lower half of 
the flask, the plaster extending to the external rim of the 
wax. The plaster is then smoothed and varnished and the 
upper section of the flask placed in position and filled with 
plaster. When the plaster is hard, the flask is heated suffi- 
ciently to soften the wax, and the parts are separated. The 
wax is then carefully and completely removed by pouring a 
stream of boiling water into the flask and over the teeth. 

After the flask has dried for a few minutes, the vents are 
cut and the two halves of the flask placed on the stove and 



54 PROSTHETIC DENTISTRY. 

heated to about the boiling-point of water. The case is now 
ready for packing. The rubber is cut in strips and thor- 
oughly warmed ; small pieces of the pink, packed between 
the teeth and strips, wide enough to extend from above the 
pins to the edge of the plate, are placed in position. The 
pins are completely covered with the red rubber, which is 
also placed over the palatal portion. No. 3 tin-foil is burn- 
ished to the model and coated with a solution of soap, which 
facilitates the removal of the foil from the vulcanite. The 
flask is closed and heated sufficiently to soften the rubber; 
the parts are then screwed together. The case is vulcanized, 
and when thoroughly cool, the plate is removed, filed, 
scraped, sandpapered and polished. 

With a protruding lower jaw, how far toward the tongue 
may the lower teeth be placed? What relation must they 
bear to the alveolar ridge? 

The lower teeth should not be placed towards the tongue 
farther than the center of the edentulous ridge. 

They should be arranged as close to the center of the 
alveolar ridge as possible. 

When would you arrange the teeth of an upper plate to 
occlude directly on the cutting edges of the lower teeth? 

In a case of a person of advanced age, where the lower 
teeth are so abraded that the masticating surfaces are per- 
fectly flat. The cusps of the upper artificial teeth should be 
ground off and the surfaces roughened. 

When a vulcanite upper plate cracks, why does the 
crack usually occur near the median line? 

It is due to the improper arrangement of the molars, in 
consequence of which the strain of mastication is thrown on 
the outside instead of on the top of the ridge. Imperfect 
vulcanization, also insufficient rubber behind the incisor teeth, 
are factors in the cause of plates cracking at or near the 
median line. It may be due to resorption of the ridge sub- 
jecting the plate to undue strain. 



PROSTHETIC DENTISTRY. 55 

How should faulty articulation of artificial teeth be cor- 
rected? 

When the articulation is slightly faulty the interfering 
points can be detected by placing a strip of carbon paper in 
the mouth and instructing the patient to bite ; the points thus 
marked should be removed with a corundum-stone. If the 
articulation is seriously faulty, the denture should be re-made. 

State how the setting of plaster may be hastened? 

By the addition of a few grains of common salt to the 
mixture. 

Mention some of the causes of failure of artificial den- 
tures. 

Imperfect impression or cast, inaccurate articulation and 
warping of the plate. 

Give a method of correcting a warped vulcanite rubber 
plate. 

A cast of the mouth is secured and thoroughly dried. The 
portion of the plate that needs correcting is heated over a 
spirit-lamp sufficiently to render the vulcanite flexible. It is 
then placed on the model, held firm, and with a heavy burn- 
ishing instrument the plate is adapted to the cast. 

State the effect of a hard center and a soft ridge on the 
fit of an upper denture. 

Unless the hard center is properly relieved, the plate will 
rock. 

A common result of wearing lower plates that accurately 
fit a model, is a tendency of the plates to bury their buccal 
edges in the soft tissues; state how this tendency may be 
overcome. 

By cutting away the buccal edge until the plate, when in 
the mouth, will not bear on the soft tissues. 

Mention some of the various methods of retaining arti- 
ficial dentures. 

Atmospheric pressure and clasps and springs. 



56 PROSTHETIC DENTISTRY. 

Give the normal occlusion of the teeth. 

All of the superior teeth overlap the lower; the six supe- 
rior anterior teeth extend over and cover part of the labial 
surface of the six inferior teeth. In the buccal region the 
buccal cusps of the superior bicuspids and molars cover the 
buccal cusps of the inferior bicuspids and molars. Each 
tooth, except the inferior central incisors and the last supe- 
rior molar strikes against two opposing teeth. 

What is your method of repairing a rubber plate frac- 
tured through the center? 

The two parts of the plate are adjusted together and held 
by means of hard wax dropped on the lingual surface. The 
palatal portion is then oiled and filled with plaster. When 
the plaster has hardened, the plate is removed from the 
model and the line of fracture enlarged with a file. With a 
jeweler's saw, dovetails are cut opposite each other, after 
which the parts are placed on the model and the prepared 
spaces filled with wax. The case is invested in the usual 
way, packed and vulcanized. 

Give the method of polishing a vulcanite plate on the 
palatal surface. 

Little or no polishing should be done to the palatal sur- 
face of a plate. A smooth, bright surface can be obtained 
by burnishing No. 3 tin-foil to the model and coating this 
with a solution of soap, just before the flask is closed prior 
to vulcanizing. 

How may a gold clasp be attached to a rubber plate? 

By soldering a perforated gold tongue to the clasp in such 
a way that it will be well embedded in the rubber when the 
plate is finished. 

What would result if an upper denture extended too far 
posteriorly and touched the soft palate? 

The muscles of the soft palate would displace the plate dur- 
ing the act of swallowing. It is also apt to cause retching. 



PROSTHETIC DENTISTRY. 57 

Describe a method of producing a very thin and rough 
vulcanite plate, both surfaces of which will be nearly 
finished when removed from the flask. 

The case is prepared for flasking in the usual manner; it 
should be smooth and as thin as the finished plate is intended 
to be. No. 60 tin-foil is burnished to the wax ; it should be 
applied in two pieces, one for the lingual surface and one 
for the buccal and labial surface. The edges of the tin-foil 
are bent out sufficiently to escape the investment in the lower 
section of the flask and, at the same time, so as to be grasped 
by the plaster when the upper section of the flask is poured. 
The case is then flasked. When the plaster is hard, the flask 
is placed in warm water to soften the wax; it is opened, the 
wax removed and boiling water poured into the flask and 
over the pins. No. 3 tin-foil is burnished to the cast and 
soaped. The waste-gates are cut and the flask dried, heated, 
packed and vulcanized in the usual manner. 

Can rubber be vulcanized in direct contact with silver? 
Give explanation. 

Rubber cannot be vulcanized in direct contact with silver 
owing to the affinity of the sulphur in the rubber for the 
silver. 

State a method of treating silver so that rubber can be 
vulcanized in contact with it. 

The silver may be gilded or coated with tin. 

Describe the method of using "Victoria" or other metal 
to strengthen or reinforce vulcanite partial dentures. 

When "Victoria" metal is used, it is cut to the desired 
size and made to conform to the shape of the mould, placing 
it so that the roughened surface will be embedded in the 
rubber, which is packed directly over the metal. When a 
bar is used, it is embedded in the rubber during the process 
of packing, so as not to show in the finished plate. 



58 PROSTHETIC DENTISTRY. 

What will be the effect on a rubber plate if it is vulcan= 
ized for twenty=four hours at 320 degrees F.? 

The rubber will become dark and very brittle. 

Describe the process of constructing an artificial den- 
ture on a celluloid base. 

The plaster impression secured, a metal cast is obtained by 
running the impression in block tin. If a vacuum-chamber 
is required, it should be cut in the impression before the 
model is poured. Taking the bite, articulating the case and 
arranging the teeth is the same as for rubber work. 

The base-plate is made of paraffin and wax compound. 
With a curved knife-blade the wax on the lingual surface 
and on the labial and buccal surfaces is carved so as to re- 
produce the natural characteristics of the gums. The wax is 
made smooth by passing it over the flame of a small burner. 
No. 60 tin-foil is then burnished over the surface of the wax. 
The case is ready for flasking; it is invested in the shallow 
half of the flask designed for this work. The plaster must 
extend just to the borders of the plate. When hard, it is 
trimmed and coated with liquid soap. The deep portion of 
the flask is adjusted and filled. When the plaster is hard 
and after sufficient heat has been applied to soften the wax, 
the two sections of the flask are separated. The wax is thor- 
oughly removed by pouring a stream of hot water over the 
mould. A groove to permit of the escape of surplus mate- 
rial is cut in the plaster encircling the matrix, but not con- 
nected with the mould. A celluloid blank of the desired size 
is selected and made to conform to the shape of the mould 
by heating it in boiling water and pressing it with the fingers 
into the section containing the teeth. The flask is then 
closed and placed in water so as to saturate the plaster. The 
case is ready for moulding, using the hot, moist-air machine. 
The flask is placed in the clamp and the top screwed down 
until it presses the flask, after which it is put in the tank 
and the heat applied. When the temperature raises to 225 



PROSTHETIC DENTISTRY. 59 

degrees F., slight pressure should be applied, and as the heat 
increases and the celluloid becomes more plastic the pressure 
is increased. This is continued until the flask is completely 
closed. The heat is then turned off and the piece allowed to 
cool gradually. When perfectly cold, the sections of the 
flask are separated and the plaster and tin-foil removed from 
the case, which is now trimmed and polished, employing the 
same instruments as used in rubber work. 

Give the composition of celluloid. 

Pyroxylin, camphor, oxid of zinc and vermilion. 

Describe the method of constructing a lower artificial 
denture made by the cheoplastic process. 

From a plaster impression a cast of equal parts plaster and 
marble dust is secured. The steps concerned in this method 
are the same as for rubber work up to the flashing. -In a 
flask designed for this work the case is invested, using equal 
parts of plaster and marble dust as investment material. 
After the investment is hard, the sections of the flask are 
separated and grooves cut from the posterior margin of the 
mould to the openings of the flask. All traces of wax are 
removed by boiling water. The mould is then thoroughly 
dried by placing the two halves of the flask over a low heat 
for an hour or more, after which the parts of the flasks are 
placed together and clamped tight. The fusible alloy is then 
melted and poured into the mould through one of the open- 
ings of the flask. When cold, the case is removed, smoothed 
with files and sandpaper, and polished with pumice-stone. 

Give the essential properties of metals used for dies. 

Hardness, low fusibility, a minimum of contractility, and 
ability to withstand the force used in swaging. 

Define die, counter=die. Mention the best metals for 
each. 

A die is a metal duplicate of a model. A counter-die is a 
cast, the counterpart of a die. 



60 PROSTHETIC DENTISTRY. 

Zinc and Babitt metal are used for dies ; lead for counter- 
dies. 

Of what is Babitt metal composed? 

Of copper one part, antimony two parts, tin eight parts. 

Give the fusing=points of tin, zinc, and lead. 

Tin about 460° F., lead about 617° P., zinc about 773° F. 

Describe a Hawes moIding=flask and state why it is used. 

It is composed of two sections or rings. The lower consists 
of three moveable pieces with extensions projecting towards 
the center, and which are held together when in use by 
means of pins passing through openings in the joints. The 
upper section is a plain ring which fits on the lower. 

It is used for securing moulds or casts with deep undercuts. 

Describe the method for making and using cores to ob- 
tain accurate moulds from models with deep undercuts. 

The surface of the undercut on the cast is oiled. A mix- 
ture of marble dust and plaster is run into the undercut and 
the wall of the model is extended so as to slant to the base 
of the cast. When this is hard it is detached from the model 
and thoroughly dried over a stove, after which it is placed 
in position on the model and the mould made, the outlines of 
the core being plainly marked. The core is then removed 
from the model and placed in its position in the mould and 
the metal poured. 

Describe a method of obtaining a correct die from a 
lower model that has several anterior teeth standing, the 
jaw very much undercut lingually below the neck of the 
teeth. 

The undercut on the model is overcome by means of two 
cores joining at the median line. A mould is then made, the 
cores are removed from the model and placed in position in 
the mould, which should be thoroughly dried and the metal 
poured. 



PROSTHETIC DENTISTRY. 61 

State the uses of aluminum in dentistry. Describe the 
method of annealing. 

Aluminum is used as a base for artificial dentures and for 
shell crowns. It is annealed by coating the metal with oil 
and holding it over a Bunsen burner until the oil is burned 
off, leaving a white surface. 

State two methods of using aluminum in the construe* 
tion of artificial dentures. 

The method of swaging and of casting. 

Describe the method of making an upper denture on 
swaged aluminum, the teeth to be attached with rubber. 

The die and counter-die secured, aluminum plate of twenty 
gauge is annealed and swaged the same as gold. The sur- 
face to which the rubber is to be attached is roughened and 
perforated. The bite and articulation secured, the teeth are 
arranged in the usual manner. The case is invested in the 
lower section of the flask, the plaster extending to the wax 
rim and imbedding the exposed metal surface (the palatal 
portion of the plate) . When the upper section of the flask 
is run and the plaster is hard, the flask is placed in warm 
water to soften the wax. It is opened, the wax removed, 
and boiling water poured over the teeth and over the plate. 
The roughened surface of the plate should be washed with 
absolute alcohol to remove all traces of the wax. The case 
is packed and vulcanized in the usual way. The rubber 
attachment is finished as usual ; the metal is polished with 
fine pumice and rouge. 

What is the fusing=point of aluminum? 

1160° F. 

Give a formula of aluminum solder suitable for dental 
purposes. 

Tin 55 parts. 

Zinc 23 " 

Silver 5 " 

Aluminum 2 " 



62 PROSTHETIC DENTISTRY. 

Give two methods of swaging a metal plate. 

A plate cut to the proper size is annealed and placed on 
the die; with a horn mallet the posterior part of the plate is 
driven into position; by this means the central part of the 
plate is brought in contact with the die at its deepest portion. 
The plate is cleansed, re-annealed and placed on the die; 
with a partial counter-die the palatal portion of the plate is 
now swaged, using a heavy swaging-hammer. The plate is 
again annealed, placed on the die and swaged with a counter- 
die extending over the alveolar ridge. The third swaging is 
done with a counter-die that extends beyond the plate line. 
Any wrinkles which have formed are removed by means of 
the horn mallet. 

The Parker's swaging device: The plate is first roughly 
swaged by means of a die and counter-die and adjusted to 
the plaster model. In this position it is placed in a cast-iron 
cylinder and covered with fine bird-shot ; this should nearly 
fill the cylinder. Over this is placed the plunger, and with 
a few blows from a heavy hammer the plate is brought into 
accurate apposition with the plaster model. 

What gauge of gold plate is used for an upper denture? 
What for a lower? State carat. 

26 gauge for an upper denture and two thicknesses of 30 
gauge each for a lower. 
18 or 20 carat. 

What is the result of over=annealing of gold or silver 
plate? 

The surface of the metal fuses, thus destroying its texture 
and rendering it more or less brittle. 

What causes gold and silver plates to warp while solder* 
ing? How can it be prevented? 

The warping is due to the contraction of the solder and 
the want of support When heated, or from excess of invest- 
ing material. It can be prevented by having the plate well 



PROSTHETIC DENTISTRY. 63 

imbedded in the investment, avoiding the use of more mate- 
rial than is needed to make a wall a half-inch thick around 
the teeth. 

What method should be used to correct a slightly 
warped plate with teeth in order to fit a plaster model? 

The plaster model should be dried so as to make it per- 
fectly hard. The plate is placed upon the model and the 
defective portion carefully noted. With a few carefully- 
directed blows from the bench-hammer the plate can be 
brought in contact with the cast. 

Describe the method of forming a rim of a full upper 
gold plate. 

A plaster impression of the gum surfaces of the teeth and 
the exposed border of the plate is taken in two sections, 
each extending from the median line to the heel. From this 
are secured models. Dies and counter-dies are obtained, and 
strips of plate of sufficient width are swaged, fitted to the 
plate and trimmed, after which the rims are held together 
with small clamps and soldered. 

State the precaution that should be taken to prevent 
gold plate from cracking during swaging. 

Frequent annealing. 

Describe the method of constructing an artificial den= 
ture on a gold base using single gum teeth. 

The plaster cast is scraped along the posterior margin of 
the plate line so as to increase the bearing of the plate at 
this point. The die and counter-dies are secured, the plate 
is well annealed and swaged. The vacuum-chamber is cut 
out and one, swaged up separately, is soldered in. The bite 
and articulation are secured and the models adjusted in the 
articulator. The teeth are ground to fit the plate accurately, 
allowing a minute space between the blocks for expansion. 
The plate with the teeth waxed in place is invested in an in- 
vestment of plaster and sand, equal parts. When the plaster 



64 PROSTHETIC DENTISTRY. 

is hard, the wax is removed and the hackings are adjusted 
to the teeth, care being taken to have them in direct contact 
with the plate. The platinum pins are split and spread 
apart to hold the backings securely in place. The case is 
then boraxed and heated preparatory to soldering. AVhen it 
is heated to redness, it is removed, placed on a soldering- 
block and soldered. When cool, the plaster is removed and 
the plate placed in a bath of sulphuric acid, after which it 
is smoothed and polished. 

How is gold solder confined to the desired surface? 

The parts to be kept free from solder are coated with a 
paste of whiting. 

Why is flux used? 

To free the surface of oxides. 

What is the proper method of directing the flow of the 
solder? 

The application of borax and the management of the blow- 
pipe. 

Describe the construction of a gold plate with rubber 
attachment. 

The plate is made and the teeth arranged precisely as they 
would be for a denture where the teeth are backed and 
soldered, except that teeth suitable for vulcanite work are 
selected. Either before the teeth are arranged, or after they 
have been waxed to the plate and adjusted in the mouth, 
a triangular gold wire about No. 18 gauge is soldered around 
the alveolar border of the plate to a little beyond the last 
molar of each side, where it should cross the ridge and be 
extended along the inner or lingual line or border of the 
rubber attachment. The object of this wire is to strengthen 
the plate, and also to hold secure the edges of the attchment 
and prevent them curling up, as otherwise they are apt to 
do after the denture has been worn for some time. To 
secure the rubber attachment to the plate, gold or platinum 



PROSTHETIC DENTISTRY. 65 

pins or wire loops are soldered on the ridge, inside the line 
of triangular wire; they should be so arranged as not to 
interfere with the teeth nor to show through the rubber 
after the denture is finished. If this is done after the teeth 
have been arranged, plaster guides should be made before 
the position of the teeth has been disturbed, so that they can 
be accurately returned to place after these additions to the 
plate have been made. The plate is now smoothed, the teeth 
arranged, and wax built out and contoured precisely as the 
rubber attachment is desired to be. The case is flasked so 
that the gold plate will be in the bottom portion of the flask 
and the teeth in the upper. It is now packed, vulcanized, 
and finished as would be a vulcanite denture. 

Is a gold lining in a vulcanite plate beneficial? Explain. 

It is, in so far as the gold prevents any irritation of the 
tissues from the rubber. 

How may an old plate be lined with gold? 

The surface of the plate to be covered with the gold is 
thoroughly cleansed with soap and water, after which the 
entire surface is roughened with a sharp-pointed instrument. 
A solution of rubber and naphtha is painted over the rough- 
ened surface and allowed to dry to the point of stickiness. 
Strips of No. 60 gold foil, one side of which have been rough- 
ened by the electro-deposition of gold, are cut of sufficient 
size to form the rim. Where there are depressions, the lining 
should be pressed with a suitably-shaped piece of rubber 
eraser to the lowest point in the plate. Each strip should 
slightly overlap the other, care being taken to avoid wrink- 
ling. The plate is then flasked in the usual way and vulcan- 
ized for twenty-five minutes at from 320° to 330° F. It will 
require no finishing except where the edges of the lining 
overlap. 

What are English tube teeth? Describe a method of 
attaching them to a gold plate. 

They are a class of plain teeth made with a platinum tube 
5 



66 PROSTHETIC DENTISTRY. 

baked in the porcelain, extending through the center of the 
tooth and corresponding to its long axis. 

The English tube teeth are attached to a gold plate by 
first grinding them to fit the position they are desired to 
occupy. They are held in place by means of hard wax. A 
marking-wire, tipped with vermilion paint, is passed down 
each tooth till it touches the plate. This marks the place at 
which the holes are to be drilled to receive the pins. The 
teeth are removed and the holes drilled. Gold pin-wire of 
the desired length is cut and the end to be inserted into the 
drilled hole is tapered so as to fit tight and project through 
on the palatal surface. The tapered end of the pin and the 
pin-hole are then boraxed and the pin soldered to the plate. 
The teeth are then placed on their respective pins and the 
final adjustment made. Previous to attaching the teeth to 
the pins, shallow grooves are made in the latter with a fine 
file. The teeth are thoroughly cleansed, dried and replaced 
on the pins. In a small porcelain receptacle sulphur is 
melted, and with a wire spatula the sulphur is conveyed to 
the plate, which is kept heated by holding it with the pliers 
over a burner. The sulphur runs under the teeth and along 
the pins. When cool, it sets hard and the teeth are immov- 
able. (American Textbook of Prosthetic Dentistry.) 

Describe a method of constructing a partial lower den= 
ture of gold, the teeth of which are soldered to the plate, 
the six anterior natural teeth being in the mouth. 

The die and counter-die are made, and a pattern of the 
desired plate is obtained in tin-foil. From this is cut two 
plates of gold, 18-carat fine and 30 gauge in thickness. The 
plates are annealed and swaged separately, the under plate 
being a little larger than the upper and both extending one- 
half on the lingual surface of the anterior teeth. The plates 
are trimmed, re-annealed and swaged together. After boil- 
ing in the acid solution, the surfaces to be soldered are pol- 
ished and boraxed. They are then placed in apposition, 
heated to redness, after which they are placed between the 



PROSTHETIC DENTISTRY. 67 

die and counter-die and with a few blows from the swaging- 
mallet are brought in absolute contact. The plates are then 
soldered with 18-carat solder. The plate is now polished, 
placed in the mouth, the bite taken, and with the antagoniz- 
ing model mounted in the articulator. The teeth are ground 
to fit the plate accurately and the backings adjusted to each. 
With hard wax the teeth are now attached to the plate and 
the case invested in a mixture of plaster and asbestos fiber. 
When thoroughly dried, it is heated to redness and soldered. 
The case is allowed to cool gradually until perfectly cold, 
when it is removed from the investment, boiled in the acid 
solution and finished with files and fine stones, using pumice 
and rouge for polishing. 

Give method of strengthening an upper or lower gold 
plate behind the anterior teeth. 

A duplicate plate, extending from the position of the bicus- 
pid of one side to the bicuspid of the other is swaged and 
soldered to the plate proper. The reinforcement for the 
lower plate should be the same width as the plate ; for an 
upper plate it should extend an eighth of an inch from the 
festooned margins to a point within the same distance of the 
edge of the vacuum-chamber. 

What is the method of repairing a cracked plate of gold? 

The parts to be soldered are cleansed. The crack in the 
palatal surface of the plate is covered with a layer of gold- 
foil and the case invested. A piece of plate is then placed 
over the crack and made to conform to the shape of the 
portion of the plate to be repaired. The investment is then 
dried and the case heated and boraxed, after which solder is 
flowed between the two plates. 

Can you solder i8=carat plate with i8=carat solder? 
Explain. 

Yes. The alloy of the solder being a low-fusing metal, the 
solder fuses at a lower temperature, although the plate and 
solder are of the same fineness. 



68 PROSTHETIC DENTISTRY. 

Describe the process of sweating together two pieces of 
gold plate of the same degree of fineness. 

The pieces are placed in apposition and, by careful manip- 
ulation of a broad, full flame of the blowpipe, the plates are 
united by partial fusing of the surfaces in contact. 

Give the fusing=point of gold, silver, copper. 

Gold, 2016° F. ; silver, 1873° F. ; copper, 2000° F. 
Give the formula for 20=carat gold plate. 

Pure gold, 20 dwts. ; copper, 2 dwts. ; silver, 2 dwts. 

Which is finer, 20=carat plate or 20=carat solder? Which 
fuses at the lower degree of heat? Why? 

They are of the same fineness. The solder being alloyed 
with a low-fusing metal, fuses at a lower temperature than 
the plate, although they are of the same fineness. (Dr. Wm. 
H. Trueman.) 

Give a formula for a 22=carat solder. 

I fold 22 parts. 

Copper 1 part. 

Silver J of 1 part 

Zinc J of 1 part. 

What is the difference between platinous gold and pla- 
tinized gold? 

Platinous gold is the alloy of gold and platinum. Platin- 
ized gold is gold covered with platinum. 

What would be the effect of placing a piece of lead on a 
gold plate during the process of annealing? 

It would impair the ductility of the gold or destroy the 
plate at the spot where the lead fuses on the gold. 

What effect has zinc on gold solder? 

It makes it flow easy. Impure, or commercial zinc also 
makes solder brittle. If the zinc is chemically pure it does 
not have this effect. 



PROSTHETIC DENTISTRY. 69 

Express in carats the fineness of American gold coin. 

21.6 carat. 

Give formula for clasp gold. 

Pure gold 20 dwts. 

Fine copper 2 " 

Fine silver 1 dwt. 

Platinum 1 " 

Give a method of making a gold clasp. State thickness 
of the metal used. 

From an accurate model of the tooth a pattern is made 
of heavy pattern-tin. This is reproduced in clasp-metal, 24 
gauge. The edges are filed to conform with those of the pat- 
tern, and the metal, well annealed, is shaped with round-nose 
pliers. 

Give method of attaching a clasp to a gold plate. 

The clasp is adjusted to the tooth in the mouth. The 
plate is placed in its position, and with a plaster impression 
the plate and clasp are removed. The model is obtained and 
the clasp attached to the plate with hard wax. They are 
then removed from the model and embedded in a mixture of 
plaster and sand. The case is then dried and soldered. 

Should a gold clasp be used about a tooth containing a 
large amalgam filling? 

There are objections. In some mouths the contact of the 
two metals may cause more or less galvanic action ; this is, 
however, usually but temporary. 

What kind of a denture should be constructed in the 
case of a patient whose superior canines and second molars 
are in position? 

A horse-shoe plate of gold or vulcanite retained in posi- 
tion by clasping the second molars. 

How are porcelain teeth attached to a metallic base? 

By means of vulcanite or by backing the teeth and solder- 
ing them to the metallic base. 



70 PROSTHETIC DENTISTRY. 

Why is platinum used for pins in teeth? 

Because it expands less under heat than any other metal 
and possesses the property of fusing at a high temperature. 

What is the fusing=point of platinum? 

3500° F. 

How would you solder platinum? 

By means of pure gold or an alloy of gold and platinum. 
What are the advantages of continuous gum? 

Cleanliness, natural appearance, durability. It is non- 
irritating and easy of repair. 

Describe the method of constructing a continuous gum 
denture. 

A platinum plate, 29 gauge for the upper or 26 for the 
lower denture, is swaged the same as in gold work. The 
outer edge is reinforced with No. 19 gauge, half-round plat- 
inum wire, bent to fit the plate along the alveolar edge to 
about an eighth of an inch from the posterior edge of the 
plate; this is soldered with pure gold. 

To the posterior edge of the plate a strip of platinum 
one-eighth of an inch wide is swaged and soldered, turning 
up the inner edge before soldering. The bite is taken in the 
usual way. The teeth (continuous gum teeth) are arranged 
and secured with hard wax. They are then coated with an 
alcoholic solution of shellac and the case is embedded in an 
investment of plaster and asbestos. When the investment is 
sufficiently hard, the wax is removed and the plate and the 
pins are thoroughly cleansed for soldering. Strips of plat- 
inum of the same gauge as the plate are then fitted to the 
palatal surface of the teeth, extending from the pins to the 
plate. The pins are then bent down over the strip, holding 
it firmly in place. 

The case is now boraxed, slowly heated, and when brought 
to a red heat it is removed and soldered with pure gold. 
When cool, the plate is taken out of the investment, cleansed 



PROSTHETIC DENTISTRY. 71 

and adjusted to the mouth. If satisfactory, the body is then 
applied. 

The body is mixed with a solution of gum-arabic and water, 
and with a small spatula it is packed around the necks of 
the teeth and spread over the surface of the plate. The gum 
is stippled to give a natural appearance. The moisture is 
absorbed with a linen cloth, and with a fine blade clean cuts 
are made between the teeth extending through the body and 
over the surface of the plate, in order to prevent distortion 
of the plate by the shrinkage of the body. 

The plate is now placed upon the investment material and 
thoroughly dried, after which it is conveyed to the mouth 
of the heated muffle, into which it is gradually introduced. 
The muffle is brought up to a white heat, and when the body 
presents shiny crystals the heat is turned off and the case 
allowed to cool gradually. When thoroughly cold, it is placed 
on the die and the incisions and cracks in the body packed 
solid with new body. The gum enamel is then applied. 
Tapping the plate gently will bring the moisture to the sur- 
face, which can be absorbed with a napkin. The case is 
dried and baked, using a higher temperature than for the 
first baking. The case is cooled as before and the metallic 
surface polished. 

What is meant by " stippling "? 

Dotting the tin-foil which is burnished over the wax gum 
with a dull-pointed instrument. By this means a more nat- 
ural appearance is produced on the gums of the finished 
denture. 

State the method of replacing a tooth broken from a 
denture of continuous gum. 

The remains of the broken tooth and the contiguous por- 
celain are ground away and a new tooth fitted in place. New 
body is then packed around the tooth, the case dried and 
biscuited. When sufficiently cool, the gum enamel is applied 
and the case baked until it becomes smooth and glossy. 



72 PROSTHETIC DENTISTRY. 

About what degree of heat is required to fuse porcelain 
in continuous gum work? 

About 2200° F. 

In continuous gum or other work in which porcelain is 
used what is the cause of the porosity sometimes found on 
breaking the piece? 

Insufficient baking, or over-beating. 

Describe the construction of an upper denture of por- 
celain. 

Two casts are taken from a plaster impression of tbe 
moutb and a thin lead plate is burnished to one of the casts. 
Softened beeswax is then placed on the ridge and the articu- 
lation obtained in the usual way. The cast and the articu- 
lating model must then be enlarged to allow for the contrac- 
tion of the porcelain in burning. To accomplish this, the 
cast and articulation are divided into four sections with a 
thin saw. The first division is made at the center, along the 
mesial line, to the back of the cast; the second division back 
of where the cuspid teeth are located. Before cutting the 
cast, the bottom should be made smooth and level. After the 
case has been divided, the sections are placed together, leav- 
ing a space of a quarter of an inch between each. This is 
filled with freshly-mixed plaster, the sections being held in 
position by wax. When the plaster is hard, a new lead plate 
is cut and burnished to the cast. -The sections of the wax 
articulating model are placed on the enlarged cast and the 
interspaces filled with melted wax; thus the model conforms 
to the size of the enlarged cast. 

An outside wall is now made for moulding the body. This 
is done by bending a piece of tin around the front and sides 
of the cast (with the wax articulating model on it) to get 
the correct curve. The tin is then removed one-fourth of an 
inch from the cast in front and at the sides, and is sustained 
in this position until freshly-mixed plaster is poured into 
the space between the cast and tin. This wall is then 



PROSTHETIC DENTISTRY. 73 

trimmed ; after the removal of the wax the wall should be 
lined with tin-foil. 

The parts are then thoroughly cleansed for moulding. The 
lead plate and inside of the wall should be oiled and a piece 
of body laid on the lead plate before the wall is put in place. 
This is worked over the edge of the gum to the limit of the 
plate line. The wall is then put in place and the body 
packed up against it. The rest of the body is pressed down 
against the surface of the lead plate, extending back as far 
as the plate is to be carried. The body is then dried suffi- 
ciently to be carved into shape. This is done roughly on the 
cast, and when reduced to the proper thickness it is dried 
and biscuit-baked. When the case is cool, the enamel is ap- 
plied and the final carving and gumming completed. It is 
then dried, placed in the muffle and burned until fully glazed. 
When cool, it is ground to fit the original cast, which was 
left unenlarged. ("American System of Dentistry.") 

What combination of metals makes a good clasp for a 
continuous gum partial case? 

Platinum and iridium. 

Give the formula of platinum solder. 

Gold 95 parts. 

Platinum 5 " 

Mention the carat and gauge of plate most desirable for 
crowns. 

22-carat and 30-gauge. 

What effect on the shade of teeth has (a) platinum, (b) 
gold backing? 

(a) Platinum gives a bluish, (b) gold a yellowish tint. 

State the precautions that should be taken in backing 
a porcelain facing to prevent checking during soldering. 

The pins should not be bent close to the tooth. 
The pin-holes in the backing should be so placed that the 
metal can be adjusted without using force. 



74 PROSTHETIC DENTISTRY. 

The backing should be in perfect contact with the porce- 
lain so as to protect it from borax. 

Upon what conditions does successful soldering depend? 

Upon the cleanliness and the contact of the two surfaces 
to be united; upon a good solder, and sufficient and proper 
distribution of heat. 

What causes porcelain facings to check and crack in 
soldering? 

Borax on the porcelain and the too sudden heating and 
cooling of the case. 

State the cause of pits in soldering. 

The use of too little borax or borax contaminated with 
sand or grit, or keeping the solder too long under insufficient 
heat, causing it to oxidize. (Dr. Wm. H. Trueman.) 

In soldering a small piece of gold to a larger piece, on 
which should the solder be placed? Why? 

The solder should be placed on the larger piece, the larger 
being harder to heat, the flow of the solder is easier directed 
towards the smaller piece. 

State which, in your opinion, is the best artificial crown 
for any of the six upper anterior teeth. Give reasons. 

Where the bite is close, a banded or partially banded 
crown, such as the Richmond, Litch or banded Logan crown, 
is most serviceable. Crowns of this style are best adapted to 
the root, possess greater strength and protect the root from 
fracture. 

Describe the method of constructing a banded Logan 
cuspid crown. 

A cap is made and adjusted to the root; it is then per- 
forated to permit the dowel of the crown to pass into the 
root. The crown is ground to fit the labial portion of the 
cap, while the lingual portion may extend one-sixteenth of an 
inch from the cap to permit of the solder. The crown is 



PROSTHETIC DENTISTRY. 75 

then removed and a piece of pure gold or platinum, 33 gauge, 
burnished to the base of the crown. It is then placed in 
position on the root and the tooth and cap united with hard 
wax, after which it is removed, invested and soldered. 

Give method of preparing a root for a Richmond crown. 

The root is trimmed to within a sixteenth of an inch of the 
gum line, except the labial portion which is cut slightly below 
the gum margin. The ridge of enamel remaining upon the 
root is thoroughly removed by means of cleavers, and with a 
fine disk the sides of the root are made smooth and parallel. 
"With a root reamer or fissure drill the canal is enlarged for 
the reception of the dowel. 

Describe a Richmond crown. 

The Richmond crown consists of a gold ferrule with a 
soldered base, through the center of which a pin is attached 
by means of solder. To the cap thus made, a facing backed 
with gold or platinum is soldered. The palatal surface of 
the crown corresponds in shape to that of the natural crown. 

In soldering a Richmond crown, how may the solder be 
drawn to the front so that a perfect joint between the 
porcelain and the gold may be obtained? 

Liquid borax is run over the labial joint and covered with 
a layer of melted wax. After the case is invested and the 
wax removed, the joint from the inside is boraxed. In sol- 
dering the heat should be applied from the under surface of 
the investment, and when sufficiently hot the solder is applied 
and made to flow through to the labial edge. 

Give a method of removing a Richmond crown in order 
to repair the broken porcelain. 

If the crown is set with gutta-percha, it can be removed 
by applying heat to the palatal surface. If set with cement, 
the band on the posterior surface is cut and forced away 
from the root. With a rose-head bur the cement between the 
cap and the root is removed. A strong instrument with the 



76 PROSTHETIC DENTISTRY. 

point bent at right angles is inserted and the crown forced 
out. It is sometimes necessary to cut the pin. 

How would you repair a Richmond crown with a broken 
facing? 

The remains of the porcelain are removed, also the back- 
ing. A facing is prepared, backed and adjusted with hard 
wax, after which it is invested and soldered. 

Describe the Bonwill crown and the method of its 
attachment to the root. 

It is an all-porcelain crown with an opening through the 
center for the passage of the supporting post. The base is 
concave and the upper portion of the opening is shaped to 
form a dovetail, which, when the crown is fixed upon its post, 
prevents its displacement. The edges of the porcelain are 
designed to rest uniformly upon the outer edge of the pre- 
pared root-surface. 

The method of its attachment consists in trimming the 
root-face as for the reception of any post crown. By means 
of a corundum-stone the crown is accurately adapted to the 
edges of the root and made to occlude properly with the an- 
tagonizing teeth. The root-canal is reamed so as to receive a 
large-sized pin and with a small wheel bur it is grooved similar 
to a screw-thread. With a corundum-wheel the porcelain on 
the base of the crown, except the edges that have been adapted 
to the root, is removed sufficient to admit of a thicker layer 
of amalgam than when the crown is in close contact with the 
root. 

Zinc phosphate is then mixed and carried to the end of the 
root-canal and the post pressed into it. The crown is now 
placed over the tin and into its proper position ; it is allowed 
to remain until the cement is hard, when it is removed and 
amalgam packed into the canal and about the pin. The con- 
cavity in the base of the crown is also packed with amalgam 
and the crown firmly pressed into position by means of a 
crown-driver, devised for that purpose. A fresh mix of amal- 



PROSTHETIC DENTISTRY. 77 

gam is packed about the pin in the cavity on the occlusal sur- 
face, which when hard, is dressed and polished. 

Describe the method of constructing a porcelain=faced 
bicuspid crown. 

A shell crown is made and fitted to the root. The buccal 
portion is cut out, leaving the band intact, at the gum margin 
to the depth of a sixteenth of an inch. A cross-pin facing 
is ground to fit the opening, backed with 33-gauge pure gold, 
and readjusted to the crown. The crown and facing are held 
together with binding wire wrapped directly over the facing, 
which should be protected from discoloration with asbestos 
fibre. Flux is added and the crown soldered by holding it 
over the flame of a Bunsen burner. 

Describe a method of constructing a bicuspid jacket 
crown with a porcelain facing fused to it. 

A ferrule is made of platinum plate of 30 gauge. This is 
fitted to the tooth. It is then trimmed to be even with the 
tooth crown. A piece of iridio-platinum plate is soldered to 
the band, allowing the buccal half to be free. Pure gold 
should be used for solder. The face of the cap is then cut 
out; the portion of the top plate which is free is shaped to 
form a cusp. A facing of the proper shade and size is ground 
to fit the opening. The porcelain is now mixed and packed 
into the spaces and against the metal to which the facing is 
to be fused. The facing is then pressed into place, the case 
carefully dried and the porcelain fused. If more body is re- 
quired, it can be added and the case re-fused. 

State the method of adding a lo\v=fusing porcelain face 
to a gold shell crown. 

A seamless crown is made and fitted to the root. The por- 
tion of the surface of the crown to which the porcelain is to 
be added, is crushed in with a few taps from the bench 
hammer ; it should be sufficient to admit of a thick body of 
porcelain. The surface is then roughened or perforated. 
The body is mixed, packed on to the gold, dried and baked. 



78 PROSTHETIC DENTISTRY. 

This is repeated until the desired shape and size is obtained, 
when the crown may be polished. 

Describe a Mason detachable porcelain=faced crown. 
State the advantage of its use and where applicable. 

It consists of a drop-forged backing of heavy gold plate 
which has a triangular slot throughout its length, and a por- 
celain facing with a triangular bar baked in the longitudinal 
axis of its lingual surface ; this is constructed so as to slip 
into the slot of the backing. 

The advantage of this crown is, that in case of fracture a 
new facing can be adjusted without necessitating the removal 
of the collar and post. It is applicable on all post and collar 
crowns or as dummies in anterior bridges. 

What advantage, if any, have Richmond crowns over 
others? 

They protect the root from fracture and decay and are 
stronger where an unusual stress has to be borne by the root. 

Describe fully the method of preparing a molar tooth 
for a gold crown. 

With carborundum stones and disks, the sides of the nat- 
ural crown and neck of the tooth are made parallel, or the 
circumference of the crown less than that of the root. 

Describe fully a method of constructing a gold cap or 
shell crown for a molar tooth, the cusps of which occlude 
accurately with the antagonizing teeth. 

The tooth properly prepared, a measurement is taken at the 
neck of the tooth by means of the dentimeter and annealed 
brass wire No. 33 gauge. The wire is cut, straightened, laid 
on the gold and a band cut of corresponding length and 
wide enough to extend from below the gum margin to within 
a sixteenth of an inch of the opposing tooth. The band is 
now annealed, the ends are beveled and united with 20-carat 
solder. The cylinder is trimmed and fitted to the tooth, the 
joint placed so as to come on the palatal aspect. It is re- 



PROSTHETIC DENTISTRY. 79 

moved, contoured and re-adjusted; a small roll of softened 
beeswax is placed in the mouth and the bite taken including 
two or three of the adjoining teeth. This is removed and a 
plaster impression taken, in which the barrel is embedded. 
A model and an articulating model are made and mounted 
upon a crown articulator. The occluding teeth are then var- 
nished, the barrel filled with soft plaster and the occlusion 
made. When the plaster is set, it is trimmed sufficient to 
expose the gold rim. Cusps and sulci are then carved in such 
a manner as to occlude properly with the antagonizing teeth. 
The collar and the plaster cusps are then pressed into mol- 
dine, removed, and Mellotte's metal poured into the mold. 
Annealed 22-carat plate 30 gauge is placed on a pine block 
and with the die the cusps are swaged. It is now trimmed, 
and adjusted to the cylinder. Both sections are pickled, the 
parts brought together and held in apposition with binding 
wire ; flux is added and the parts united with 20-carat solder 
by holding them over the Bunsen flame. The crown is then 
trimmed and polished. 

How would you repair a gold cap with a hole in it? 

The crown is boiled in acid, after which the hole is filled 
with a large pellet of soft gold and solder flowed over. 

How would you remove a gold crown from a diseased 
molar tooth? 

The palatal surface of the crown is slit with either a chisel 
or cutter devised for that purpose, and the laps of gold 
pulled away from the tooth. A sharp-pointed instrument is 
then worked between it and the crown surface of the tooth, 
and with slight pressure the crown can be forced away from 
the tooth. 

Give details of constructing a gold cap for a cuspid. 

The measurement of the root to be crowned is taken with 
an annealed copper strip which is placed around the root and 
grasped firmly with pliers. The strip is removed, the surplus 
ends trimmed and the band cut through the center. The re- 



80 PROSTHETIC DENTISTRY. 

speetive halves are bent over the lingual and labial forms 
of a Holingsworth mould-plate. When the proper form is 
selected, it is placed on the moulding plate with a rubber ring 
around it; into this is poured Mellotte's metal and a die of 
the two surfaces secured. Annealed 22-carat, 30-gauge gold 
is placed over the die and the sections swaged separately. 
They are now boiled in acid, the edge smoothed and trimmed, 
the parts brought together and held with binding wire. Flux 
is applied and the halves united with 20-carat solder. 

Describe the method of constructing a bicuspid crown 
with a porcelain front for a tooth having a vital pulp. 

The tooth is trimmed for the reception of the collar. Suffi- 
cient of the buccal surface of the tooth is removed to accom- 
modate the porcelain, care being taken not to injure the pulp. 
A seamless gold crown is then made a*nd fitted on the tooth ; 
the buccal surface is cut out, leaving intact a sixteenth of an 
inch, the portion extending above the gum line. No. 60 gold- 
foil is burnished on the tooth and, while in place, the crown 
is adjusted; through the opening cut for the facing a small 
nodule of soft beeswax is forced. The crown with the wax 
and gold-foil is removed and invested in a mixture of silex 
and plaster. The case is then dried, the wax thoroughly re- 
moved and low-fusing body packed into the space occupied 
by the wax and over the face of the crown. This is baked, 
after which sufficient porcelain is added to give the desired 
shape and size. It is again baked and the crown polished. 

What style of a crown would you use to restore abraded 
front teeth? 

A barrel crown of either gold or platinum with a veneer 
soldered or fused to it. 

Describe the Davis crown. State how you would adjust 
it to the root. 

The Davis crown consists of two parts : The pin, which is 
separate from the crown, and the crown itself. The crown is 
all-porcelain with an opening extending well into the body 



PROSTHETIC DENTISTRY. 81 

for the reception of the pin. In adjusting it, the edges of 
the crown are ground to fit the face of the root accurately. 
The root canal is reamed to receive the pin, which is cemented 
into the canal. The cavity in the crown is then filled with 
cement and the crown placed over the pin is forced into 
position. 

What is the advantage of the Davis crown? 

In case of fracture a new crown can be adjusted without 
removing the dowel. 

Describe the process of making a molar crown with a 
gold band and a saddle=back or plain rubber tooth. 

A ferrule is made as for an all-gold crown. A bite and 
impression are taken and the models mounted upon a crown 
articulator. A wire measurement is then taken of the cir- 
cumference of the upper portion of the ferrule. A tooth is 
selected, the circumference of which is the same as that of the 
ferrule. The buccal face of the ferrule is cut out, except the 
slight rim- of gold extending beneath the gum. By means of 
corundum-wheels the edges of the porcelain are made to fit 
the edges of the gold at the cervical and approximal borders, 
care being taken to have the articulation perfect. Pure gold 
No. 35 gauge is burnished to the under-surface of the porce- 
lain ; it is now adjusted to the barrel, invested and soldered. 

Describe a method of making and attaching a swaged 
shell corner for a central incisor, the cavity of which in- 
volves both labial and lingual wall and the masticating 
surface. 

The tooth is thoroughly excavated; the enamel edges 
beveled and smoothed. A small piece of softened modeling 
compound is pressed into the cavity and allowed to harden, 
when it is removed and with a sharp-bladed instrument 
trimmed and carved to correspond to the desired shape of 
the corner. It is then pressed into "moldine" and a die of 
Mellotte's metal made. Annealed 24-carat gold 30 gauge is 
6 



82 PROSTHETIC DENTISTRY. 

swaged ; the edges are trimmed and made to slightly overlap 
the cavity margins. The shell is re-inforced with 20-carat 
solder, to which two pins, made to extend well into the 
cavity, are soldered. The corner is now polished and ad- 
justed by first filling the cavity, then the shell with cement; 
it is now placed in position and held until the cement is hard. 
That which oozes out is removed and the margins coated 
with varnish. 

Describe the method of preparing a root for the recep- 
tion of a Biittner crown. 

A special set of instruments is required for this process: 
drill, root-facer and trephine. The root-facer, guided by a 
central pin, cuts the face of the root level. The drill is used 
to open and enlarge the canal, and by means of the trephine 
the neck of the root is made cylindrical. 

Describe the method of preparing and attaching a por- 
celain tip (lower third) to a central incisor with a vital 
pulp. 

The surface of the tooth is made smooth and square. To 
this is burnished a piece of platinum plate No. 35. With the 
plate in position on the tooth, three holes are drilled as deep 
as may be done without injuring the pulp; in each of the 
openings a post is placed and adhesive wax flowed over the 
projecting ends, attaching them to the plate. The plate is 
then carefully removed, invested, and the pins united to the 
plate with pure gold. The piece is placed on the root, the 
pins trimmed to within a thirty-second of an inch of the 
plate, care being taken to have the plate well burnished. A 
plaster impression is taken and removed with the small plate 
embedded in it. A model is made with sand and plaster, 
which when hard, is carefully removed from the impression. 
A cross pin tooth of the desired shape and size and with the 
pins close to the cutting edge is selected. The facing is then 
cut down to about the desired length and the final fitting to 
the tooth made with a fine grit stone. It is then backed with 



PROSTHETIC DENTISTRY. 83 

platinum No. 28, attached to the plate with sticky wax and 
invested in sand and plaster. When dried, the case is sol- 
dered with 22-carat solder. In setting it, the rubber dam is 
adjusted to the tooth, the holes in the tooth are filled with 
soft cement and the tip is placed in position; it should be 
held firm until the cement is hard. 

What are the requisites of a crown? 

It must protect the root from decay and should restore the 
appearance and the function of the natural tooth. 

In bridge=work should the teeth fit the gum perfectly or 
should a space be left between the gum and the bridge? 
Explain. 

A space should be left between the gum and the teeth in 
order to facilitate cleansing. 



■•&" 



Describe the construction of a bridge to replace the in= 
ferior central incisors, the remaining teeth being sound 
and in place. 

With disks and corundum-wheels the lateral incisors are 
prepared for the reception of open-face crowns which are 
made of 22-carat gold, 29 gauge. The crowns are adjusted to 
the teeth, and a wax bite and a plaster impression are taken 
with the crowns in place ; when the impression is removed, 
the crowns, if not imbedded in the plaster, should be placed 
in their respective position in the impression. The model is 
run with plaster and marble dust and with the articulating 
model it is mounted on the crown articulator. Facings of the 
desired shape and size are selected, backed and adjusted to 
the cast with hard wax. The case is now invested, dried and 
heated, the borax applied and the case soldered. 

Describe a method of constructing a gold bridge to re= 
place lost teeth between the cuspid and second molar, both 
named teeth being in place and sound. 

The cuspid tooth is devitalized, the pulp extirpated and the 
natural crown cut off. The root is then prepared for the re- 



84 PROSTHETIC DENTISTRY. 

ception of a collar crown which is made and adjusted. The 
molar tooth is prepared and a shell crown made of 22-carat 
gold, 29 gauge. This is placed in position and a wax bite 
taken of the entire side. An impression of the antagonizing 
teeth is taken in wax and the model poured. A plaster im- 
pression is now taken with the crowns in position which 
should be imbedded in the plaster when the impression is re- 
moved. A model is then run and with the articulating model 
it is mounted on the articulator. The bicuspids and the 
molar facings are selected and ground to fit the model, the 
upper edge extending to within a few lines of the gum. 

The occluding edge of the facing — ground to within a 
sixteenth of an inch of contact with the opposing teeth — is 
beveled toward the outer edge. 

Backings are fitted to the facings, extending from the 
cutting edge to near the gum line. Cusps for the respective 
teeth are then swaged on a die-plate and fitted to the facings. 
They are united with hard wax, invested and soldered separ- 
ately with 20-carat solder, using sufficient to give the proper 
shape. When cool, they are boiled in acid and mounted on 
the cast, to which they are attached with hard wax. The 
bridge is now carefully removed from the articulator and 
embedded in an investment of plaster and asbestos fibre; it 
is dried, heated in the furnace, boraxed and soldered. When 
cold, it is removed from the investment, boiled in the acid, 
trimmed and polished. 

State the method of making the grinding surface of a 
bridge with one continuous piece of gold. 

The abutment crowns in place, a bite and plaster impres- 
sion are taken and the models mounted on the articulator. 
Suitable facings are selected and fitted to the cast. The cut- 
ting edges are shortened sufficient to permit of a protecting 
covering of gold. The backings are adapted, the facings in- 
vested and solder flowed over the backings, having the pins 
well covered with the solder. They are now trimmed, ad- 
justed to the cast and a roll of softened beeswax is placed 



PROSTHETIC DENTISTRY. 85 

between the abutments and extended over the cutting edge 
of the facings. The cusps of the antagonizing teeth are oiled, 
as is also the surface of the wax, which is again warmed and 
the jaws of the articulator brought together. When separ- 
ated, the cusps and sulci are carved to occlude accurately 
with the antagonizing teeth. The wax cusps are then re- 
moved from the model and embedded in a mixture of plaster. 
A rim of thin copper about an inch in width is placed around 
the wax and in the soft plaster. When the plaster is hard, 
it is placed over a burner and gradually heated until the 
wax is soft enough to be removed. When the mould is thor- 
oughly dried, it is run with Mellotte's metal. On the die 
thus secured a strip of annealed gold 22-carat 30 gauge is 
swaged. This is boiled in acid, the edges trimmed and the 
cusps re-inforced with 20-carat solder. It is then placed on 
the model and the facings adjusted to their proper position. 
The case is now invested and soldered in the usual way. 

Give a method of making and attaching a removable 
bridge. 

The abutments are properly prepared and collars with flat 
tops are made and cemented in place. Telescoping caps are 
then constructed and fitted over the barrel-covered abutments. 
A bite and an impression are taken, the caps being embedded 
in the impression. Models are made and mounted on the 
articulator. The dummies are made and soldered to the caps. 
The bridge is then trimmed and polished. The caps are 
warmed, lined with a film of gutta-percha, placed in posi- 
tion over the barrel-covered abutments and the bridge forced 
into place. 

If a bridge, extending from the canine to the third molar, 
breaks in the middle, what is the method of repairing it? 

The bridge is removed, boiled in acid and re-adjusted in 
the mouth. By means of a plaster matrix it is removed, in- 
vested and soldered. 



86 PROSTHETIC DENTISTRY. 

How should the loss of a superior lateral incisor be 
supplied? 

An impression, including the adjoining teeth, is taken and 
a die made. Gold plate, 22-carat, 29 gauge is swaged to the 
palatal surface of the cuspid and central incisor. Holes are 
drilled in the palatal surface of each tooth extending into 
the dentin, care being taken not to encroach upon the pulp; 
the openings should be well undercut and large enough to 
accommodate a flat-headed platinum pin. The plates are 
then placed in position, a hole corresponding to the one in 
the tooth is drilled and the pin inserted and united to the 
plate with sticky wax. The plates are removed, invested and 
soldered with 22-carat solder. They are then adjusted to the 
teeth and held with a little soft gutta-percha. A plaster im- 
pression is taken with the plates in position ; when removed, 
the plates are placed in position in the impression and the 
model run in plaster and marble dust. A facing is selected, 
backed and fitted to the model, it is attached to the backings 
with hard wax. The case is then invested and soldered. 

Describe a method of constructing a bridge extending 
from a lower first bicuspid to a third molar, both teeth 
inclining towards each other. 

Abutment caps are constructed with square tubes soldered 
to the distal surface of the bicuspid and mesial surface of 
the molar. A bar, extending across the space, is bent so that 
the ends will slip into the tubes. The abutments are placed 
on the teeth and a bite and plaster impression taken. The 
crowns are then placed in their position in the impression 
and the models made and mounted. The bar is now adjusted 
to its place and plain rubber teeth waxed to the bar. The 
teeth and bar are removed from the cast, the case is flashed, 
packed and vulcanized. The crowns are cemented in place 
and the bar, with the teeth vulcanized to it, is slipped into 
position. 

What is the object of an investment? 

The protection of the porcelain from the flame, to afford 



PROSTHETIC DENTISTRY. 87 

attachment, and to support in proper position the parts to 
be soldered. 

What is the best investment for crown and bridge work? 

A combination of fibre asbestos and plaster of Paris. 
Why is silver not used in crown and bridge work? 

Because it is soon corroded by the oral secretion. 

How may a badly decayed root be re=inforced or 
strengthened sufficiently to carry a dowel or pin crown? 

The decay should be removed and the tooth thoroughly 
sterilized with nitrate of silver. Small grooves are cut with 
a wheel-bur in the root canal, which has been well reamed. 
The canal is then packed with amalgam, and while soft a steel 
pin is forced well up in the center. More amalgam is added 
and banked up around the pin. The amalgam is then held 
firmly with the fingers of one hand, while the pin is carefully 
removed with the other. 

Give method of taking an impression of a root for a 
gold crown. 

An annealed copper band is shaped and placed on the root ; 
while in position, an impression is taken with plaster in a 
small tray. 

State the difference in degrees between the boiling- 
point of water and the fusing=point of gold. 

About 1804 degrees. 

Describe Brown's porcelain bridge, stating advantages 
and disadvantages. 

It consists of a rigid supporting and anchoring bar to 
which are adjusted porcelain teeth, attached to the bar by 
means of porcelain fused about the parts. 

The advantages claimed for it are : that it is less liable to 
fracture than facings employed in the regular bridge; its 
natural appearances and cleanliness. Its disadvantage is, 
that in many cases its application necessitates the mutilation 
of sound teeth. 



88 PROSTHETIC DENTISTRY. 

How would you secure an anchoring bar to a vital tooth? 

By means of a filling of cohesive gold, which should be 
inserted with the electric mallet. In the posterior teeth amal- 
gam can be used for the same purpose. 

State the method of preparing and filling a cavity in a 
porcelain tooth. 

The cavity is prepared by means of a diamond-pointed drill. 
The tooth is placed in plaster to facilitate holding it during 
the process of filling, which is done in the usual way. 

At what age is the regulating of the teeth permissible? 

At about the ninth year, or as soon as appliances can be 
used to advantage. 

State the principle of Farrar's system of regulating. 

The moving of teeth should be by force that is positive in 
character. 

Describe Dr. Farrar's appliance for moving roots for- 
ward. 

"The base of support is a transpalatal screw-jack, an- 
chored by two clamp bands that embrace the side teeth ; from 
this jack to the posterior sides of the necks of the incisors 
are two other screw-jacks to press against these front teeth. 
To hold these jacks upon them, a broad band with a U-shaped 
lug soldered on the lingual side is cemented to each incisor 
in which a bar connecting the anterior ends of the jack rests. 
To hold firmly the end of the crown of each incisor, and to 
prevent them from moving forward when the jacks are set 
at work against the necks of the teeth, the ends are tied to 
the transpalatal jack by two wire cords connected with a 
cross bar lodged in other U-shaped lugs soldered to the labial 
side of the bands." (The American Text-Book of Operative 
Dentistry.) 

Describe Dr. Farrar's appliance for moving roots back. 

"The crowns are stayed by an inside rectangular frame 
resting in U-shaped lugs at the ends of the crowns and braced 



PROSTHETIC DENTISTRY. 89 

against nuts soldered, to two anchor clamp-bands on the side 
teeth. The roots are drawn back by a labial bow, attached to 
the clamp-bands by screws." 

Describe the Jackson crib and base wire. 

It consists of a base wire, No. 13 or 14 B. & S. gauge, con- 
necting cribs placed on the two opposite molars or bicuspids, 
and bent in a bow corresponding to the lingual surfaces of 
the teeth. To this base wire are soldered springs for moving 
teeth in different directions according to the requirements of 
the case. 

State a method of rotating a lateral incisor. 

It can be rotated by means of piano wire soldered to a 
band which is cemented to the lateral incisor, the free end 
of the wire held by a lug on the second bicuspid band. 

Describe the Angle method of retracting a protruding 
lower jaw. 

A large traction screw is attached to clamp-bands which 
encircle the first lower molars. The ends of the bar are 
hooked into small staples soldered to the distal angles of 
bands upon the canines; while a piece of gold wire attached 
by solder connects these bands and passes in front of the in- 
cisors. This appliance is used in conjunction with a metal 
cup swaged to fit the chin and connected by rubber bands 
with a cap on the back of the head. 

Describe a method of bringing into proper position a 
right upper cuspid that bites inside the circle of the lower 
teeth. 

A jack-screw extending from the palatal surface of the 
first bicuspid to the palatal surface of the cuspid is adjusted. 
By turning the screw a little each day the cuspid will be 
forced into position. 

Describe Angle's appliance for retracting a cuspid. 

Angle's drag-screw consists of a stiff wire, screw-cut at one 
end and bent into a hook at the other. Anchorage is secured 



90 PROSTHETIC DENTISTRY. 

by soldering a tube to a molar and a bicuspid band. The 
screw-cut end is passed through the tube and the nut placed 
in position. The end with the hook is slipped into a tube 
soldered to a band which is cemented on the cuspid. 

Give a method of elongating bicuspids when they fail to 
occlude properly. 

Bands to which hooks are soldered are cemented to the 
upper and lower bicuspid teeth. A rubber band is stretched 
from the hooks on the upper bicuspids to the corresponding 
ones on the lower bands. 

Describe Dr. Case's appliance for raising the occlusion 
of the lower bicuspids. 

On each bicuspid is cemented a band with a buccal hook 
pointing downward. On the band for the molars is soldered 
a hollow tube. On the incisors are cemented bands with 
hooks turned upward. A labial bow of piano wire with the 
ends inserted in the tubes on the molars' bands, the front 
resting above the hooks on the incisors and the sides pressed 
under the hooks on the bicuspids. 

Describe Case's retainer for the anterior teeth. 

It consists of a series of bands soldered together at their 
point of contact with an excess of solder in front. The labial 
surface of all but the end bands are cut away, so as to leave 
only a small portion between the teeth; these are filed so as 
to resemble gold fillings. The appliance is stiffened by sol- 
dering a piece of swaged plate to the lingual surface. 

Describe a simple retainer for a single tooth that has 
been rotated. 

A wire is soldered to the labial surface of a band which is 
cemented to the tooth. The wire should project so as to rest 
on the labial surface of the adjoining teeth. 

Describe an appliance for expanding or enlarging the 
arch 

Wide bands are made for the first bicuspid and first molar 



PROSTHETIC DENTISTRY. 91 

of each side. The bands on each side are joined by a bar 
soldered to the lingual surface. This bar is made of clasp 
gold of No. 22 gauge and should be about one-eighth of an 
inch wide ; in this holes are punched at short intervals. 
Angle's jack-screw is then adjusted, placing the pointed end 
of the tube in a hole in the bar on one side, and one prong 
of the forked end in a hole in the opposite bar. The force 
is applied by turning the nut. 

Give the method of obtaining an impression of a per= 
forated hard palate. 

With quick-setting plaster the cavity above the roof of the 
mouth is filled even with the border of the fissure, and while 
soft, the palatal impression is taken and retained in position 
until the plaster is hard. The palatal surface of the plaster 
above the roof of the mouth should be coated with a solu- 
tion of soap to prevent the two masses from adhering when 
brought in contact. The impression of the palate is removed 
in the usual way and with a pair of pliers the mass from the 
nasal portion is carried backward and withdrawn from the 
mouth. The two portions are then placed together and 
waxed. 

Give the method of taking an impression of a cleft 
palate. 

An impression tray of the proper size is selected ; it should 
extend slightly beyond the posterior borders of the hard pal- 
ate. It is sometimes necessary to lengthen the tray by means 
of a flap of base-plate gutta-percha, which may be carried 
back as far as the uvula. Plaster of Paris mixed in the usual 
way is placed in the tray, care being taken not to use too 
much. The tray is introduced into the mouth and pressed 
up quickly and firmly, holding it in place until the plaster 
will break with a clear fracture, when it is removed. 

What is an obturator? 

It is an appliance employed to close an opening in the hard 
or soft palate. 



92 PROSTHETIC DENTISTRY. 

Define an artificial velum. 

It is an appliance made to supply the loss of the posterior 
soft palate. 

Describe the method of constructing an obturator. 

A model having been obtained, the fissure in the hard 
palate is filled with wax. Dies are made and a gold plate 
swaged to fit the reconstructed model. The plate is provided 
with an extension at the posterior extremity which is to sup- 
port the obturator and is attached to the teeth by clasping 
the six-year molars. The plate is then fitted to the mouth 
and a loop of copper wire soldered (with soft solder) to the 
upper side of the plate and extended backwards about two-, 
thirds of the length of the fissure. A mass of softened bees- 
wax is wrapped about the wire loop and shaped to correspond 
to the fissure. It is then slightly softened in warm water 
and placed in the mouth; the patient is directed to swallow 
several times; by this means the softened mass is moulded 
to the required shape. When removed from the mouth, the 
palatal surface is trimmed into a continuous flat surface ; the 
upper surface is treated similarly. In the region of the uvula 
the sides must be trimmed away so that they may close under 
the obturator. Plaster is then mixed and a little placed 
upon the upper side of the plate, extending from the wax 
bulb forward to reach the end of the fissure when placed in 
the mouth. The plate with plaster upon it is then introduced 
in the mouth and carried into place. By this means an im- 
pression of the forward part of the cleft is obtained. Plaster 
moulds are now made and the case flasked. Before packing, 
patterns of the upper and under surfaces of the bulb are cut 
from No. 60 tin-foil, and a single pattern to extend around 
the sides and end. These are reproduced from sheet rubber 
and are united to form the bulb by placing the edges tight 
together. Before finally closing, water should be introduced, 
filling the bulb about half full, care being taken that the 
edges of the rubber do not become wet. The flask is closed 



PROSTHETIC DENTISTRY. 93 

and the case vulcanized. The bulb is then fitted to the plate. 
A hole is drilled through the bulb and plate, through which 
an iridio-platinum bar is passed and soldered to the plate, the 
opposite end being screw-cut and supplied with a nut. The 
surface of the plate, on which the bulb is to lie, is smeared 
with gutta-percha, the bulb slipped over the bar, and the nut 
screwed down until it impinges. The plate is then warmed 
over a burner, the gutta-percha softened and the nut screwed 
tight. The plate and bulb are trimmed and polished. 

Describe the method and material you would use to 
secure a perfect impression of the inferior maxilla when 
fractured. 

Plaster of Paris is prepared and placed upon the oiled 
surface of a large impression tray. The fragments of the 
jaw should be held in position by an assistant and the tray 
introduced and carefully pressed into place. When the plas- 
ter is hardened, the tray is detached and by means of a sharp 
instrument the impression is cut and removed in sections. 
The pieces are replaced on the tray and held together with 
was. 

Describe the method of constructing an interdental 
splint. 

The model of both jaws being obtained, they are carefully 
articulated by cutting with a small saw the lower cast at 
the point of fracture. The sections are re-arranged so as to 
bring the teeth of the two models into proper articulation. 
They are then secured with plaster and the two models 
mounted on the articulator. The interdental dovetail spaces 
are filled with soft plaster. 

The bite is opened about half an inch by means of the set- 
screw in the articulator. The teeth and a portion of the 
gums of both casts are covered with No. 60 tin-foil. A layer 
of rubber is then cut so as to completely cover the foil, one 
for the upper and one for the lower cast. The rubber is 
warmed and with a hot instrument it is adapted and fastened 



94 PROSTHETIC DENTISTRY. 

to the cast. The articulator with the casts is then brought 
into proper position and united with rubber posts placed in 
the position of the cuspids and molars. With a hot spatula 
the surface of the rubber is made smooth and the edges 
fastened to the plaster. The case is now ready for flasking. 
Soft plaster is run into the interior of the moulds which are 
then embedded in a large flask containing soft plaster. The 
case is vulcanized and finished in the usual manner. 

State the relative merits of gutta=percha and cement 
as a retentive medium for crowns and bridges. 

The adhesive properties, as well as the hardness, of oxy- 
phosphate render it valuable in such cases as require rigidity 
and support. 

Gutta-percha is valuable in cases where removal may be 
desirable and where the retentive medium is exposed to the 
fluids of the mouth. 

Describe the Bonwill articulator. 

It is composed of brass wire and tubing, and consists of a 
base and a pair of bows. The upper bow is narrower than 
the lower bow ; they are detachable by loosening the set- 
screws. At either extremity of the cross-bar is an eyelet, 
through which the "condyle" of the articulator works. 
Back of the condyle are two spiral springs which represent 
the muscles. This construction permits the side motions of 
the lower jaw to be fairly well imitated. 

State the method of facing a black rubber plate with 
pink rubber by vulcanizing once. 

The preparatory steps for flasking and packing are the 
same as for the ordinary case. Strips of pink rubber are 
placed between the teeth, and extending from above the pins 
to the top of the rim. A layer of pink rubber, the exact size 
and shape of the palatal portion of the plate, is cut and 
placed in position, care being taken to have no spaces or 
crevices. A sheet of black rubber is stretched to one-half its 
regular thickness. It is cut to the desired shape and size 



PROSTHETIC DENTISTRY. 95 

and placed in position over the pink; the edges should be 
neatly packed about the pins. A piece of holland is placed 
over the rubber, the flask closed, heated, and the bolts tight- 
ened. The flask is then opened, the cloth removed, and a 
narrow rim or roll of black rubber, extending from heel to 
heel of the plate, is placed at the junction of the black and 
pink rubber. The flask is closed and the case vulcanized. 

Describe the method of reproducing the rugae in a vul= 
canite plate. State the advantage. 

Heavy tin-foil is swaged or burnished upon the palatal 
portion of a model having well-defined rugae. The tin-foil 
is carefully removed and the lines of the rugae neatly filled 
with yellow beeswax. The tin-foil is then fitted to the palatal 
portion of the denture while it is in the lower section of the 
flask and before the upper section has been filled with plaster. 
The beeswax in the lines of the rugae prevent their being 
crushed while the tin-foil is being made to conform to the 
palatal surface of the denture. When this has been adjusted, 
the flasking is completed and the case finished. The tin-foil 
imparts to the vulcanite a polished surface, and no smooth- 
ing is needed on this portion of the plate. 

The advantages of the rugae on the vulcanite plate are : 
the tendency to lisp is greatly lessened, it has a more natural 
feeling to the tongue, and pronunciation is assisted. 

How may the extreme limit of the posterior border of 
an upper plate be determined? 

By the degree of sensitiveness of the tissues to the plate. 
The posterior border should not encroach upon the soft palate 
nor should it cause discomfort to the patient. 

How would you repair a broken clasp on a rubber plate? 

A new clasp should be made and attached to the plate by 
vulcanizing. 

What are the uses of silex in dentistry? 

To prevent the adhesion of plaster to, and to produce a 



96 PROSTHETIC DENTISTRY. 

smooth surface on vulcanite. It is used also to unite por- 
tions of a broken plaster model. 

Describe the blowpipe invented by Dr. J. Rollo Knapp 
and state some of its uses. 

It consists of blowpipe attachments connected with a 
nitrous oxide gas cylinder, the cylinder being set upright 
and attached to an iron base, at the other end of which is a 
movable table upon which to rest the work. The blowpipe 
proper is a continuation of the outlet tube of the gas cylin- 
der. A lever-valve regulates the supply of nitrous oxide. 
Beyond this valve is the mixing chamber, to which illumin- 
ating gas is conducted from the gas-pipe through a rubber 
tubing entering the botton of the chamber. The mixing 
chamber is provided with a gauze screen to prevent the flame 
from being drawn into the tubes. Beyond the mixing cham- 
ber a pipe is branched so as to afford two flames of different 
sizes. It is practically an oxy-hydrogen blowpipe. It may 
be used to melt small quantities of platinum, but it is espec- 
ially useful in crown and bridge-work manipulations, where 
an extremely high temperature is required to fuse metals 
so quickly that the heat will not extend beyond where it is 
required. 

Describe the treatment of prognathism. 

The treatment consists in forcing back the body of the 
lower jaw into a more posterior position in its relations to 
the upper, partly by bending the rami and necks of the con- 
dyles and partly by absorption of the posterior wall of the 
glenoid fossa. This is accomplished by means of caps fitted 
to the head and chin, united so as to exert a uniform pressure 
on the surfaces upon which they rest. 

Describe the Norton=Talbot spring and give the method 
of using it in expanding the arch. 

It is a spring of piano wire, Nos. 20-24, B. & S. gauge, 
coiled upon itself one or more times. 

It is applied by fitting the ends of the spring into holes 



PROSTHETIC DENTISTRY. 97 

made in a bar connecting the bands on the lingual surfaces 
of the teeth. 

Describe the Matteson lingual bow and give method of 
attachment for moving the upper central incisors forward. 

It consists of molar and bicuspid bands joined by a strip 
on the buccal surface and a piece of metal tubing closed at 
one end on the palatal surface. A piano wire is inserted in 
the tube and the free end allowed to press on the teeth to be 
moved. The end is held in position by means of a tag united 
to the band, which is cemented on the tooth. 

Describe a labial bow and hook = band and its application 
for rotating a lateral incisor. 

It consists of bicuspid bands, one for each side, with tubes 
soldered on the buccal surface of each. Into these tubes the 
ends of the labial bow are inserted. A band with a hook sol- 
dered on the lingual surface is cemented to the lateral in- 
cisor. A rubber band is caught over the hook and attached 
to the bar. 

Describe an occipital appliance and yoke used for re= 
tracing and shortening the upper central incisors. 

It consists of a frame of gold fitting to the cutting edge of 
the incisors and lapping on to the canines. To this is sol- ' 
dered a stud or post a half-inch in length extending out of 
each corner of the mouth. The ends are bent in the form of 
a hook, and are made to extend far enough from the cheek to 
permit of rubber bands or ligatures extending to a scull-cap 
without impinging on the cheeks. The occipital cap is made 
of two pieces of silesia with dress-hooks sowed at each side 
to afford attachment to the ligatures. 

Describe the Magill band and its methods of attachment. 

It consists of a strip of metal Nos. 30-36 gauge and about 
one-eighth of an inch in width. This is bent around the 
tooth and soldered at the overlapping ends. It is held in 
position by means of zinc phosphate cement. 

7 



98 PROSTHETIC DENTISTRY. 

State the six directions in which the various teeth may 
be moved in adjusting irregularities. 

Forward, backward, inward, outward, upward, downward. 
Differentiate the terms occlusion and articulation. 

The occlusion of the teeth is the relative position of the 
upper and lower teeth as they naturally close together, with 
the cusps of the teeth of one arch resting in the sulci of those 
of the opposite arch. 

Articulation implies the relation of the lower teeth to the 
upper in the several movements of the mandible during the 
act of mastication. 

Describe a simple but accurate method of securing a 
profile record of the face in regulating cases. 

A piece of soft lead wire about one-eighth of an inch in 
diameter is shaped with the fingers to the contour of the 
features at the median line from the forehead to the chin. 
It should not be permitted to press unequally on any part. 
The wire is then placed on a strong cardboard, care taken to 
prevent its bending. With a fine-pointed pencil the outline 
of the wire is traced on the cardboard; this is then cut ac- 
cording to the penciled line. The card will fit to the profile 
of the features. 

Describe a facial goniometer and explain its use. 

It is composed of a semicircle to which two arms of steel 
are attached. One of these has no movement of rotation but 
moves horizontally on the pins, its upper edge always re- 
maining at zero. The other is movable on the pin and can 
be made to assume any angle with the horizontal arm; one 
of its edges is beveled to facilitate reading the angles. The 
arms can be lengthened or shortened at will. 

It is used for measuring facial angles. 

Describe the Justi removable=pin crown. 

It consists of a porcelain crown and a detachable pin. The 
crown has a ridge which extends the entire length of the lin- 



PROSTHETIC DENTISTRY. 99 

gual side of the opening or recess into which the pin fits. On 
the labial side are three deep grooves or undercuts. The 
opening is horshshoe-shaped, and contains also a cup-shaped 
depression at the neck. The pin is flattened on the lingual 
side; it is deeply serrated and has a slot or groove at the 
base which fits over the ridge in the crown. 

State some of the changes in position, form, and color 
of the teeth that occur in a natural denture with advanc- 
ing years. 

There is a tendency for the teeth to move forward and to 
elongate; also a wearing down from abrasion. The teeth 
darken in color, assuming, generally, a deep yellowish hue. 

Describe the Griswold retainer for artificial dentures. 

It consists of a V-shaped tube, corrugated, called the 
"spring"; this is soldered to a crown. A counter part is 
made to fit over it with corresponding corrugations called 
the "box." The box is located in the denture. The corru- 
gations on the spring and those on the box interlock and 
form a distinct locking device which holds the denture firmly 
in place. 

Of what value is kaolin in porcelain bodies? 

It gives plasticity and imparts strength. 

Mention the material that is used as flux for reducing 
the fusing-point of porcelain enamels. 

Flux (glass) ; a composition of powdered silica, glass of 
borax and potassium carbonate. 

What frit is used to produce porcelain-gum enamel? 

Purple of cassia, feldspar, quartz, glass of borax, and car- 
bonate of potassium. 

Give the composition of spelter solder sometimes used 
in the preparation of gold solder for the purpose of reduc- 
ing the fusing=point. 

It is an alloy of copper and zinc, containing more zinc so 



100 PROSTHETIC DENTISTRY. 

as to make it more fusible than the alloy of zinc known as 
brass. 

What special quality has borax which makes it such an 
admirable flux in soldering and melting metals? 

At a high temperature the salt fuses and becomes glass, in 
which state it possesses the property of dissolving metallic 
oxides. 

Give a formula for a 20=carat gold clasp metal. 

Pure gold 20 

Silver 2 

Copper 1 

Platinum 1 



ORAL SURGERY. 



What conditions are necessary to obtain bony consoli- 
dation after fracture? 

Accurate apposition of the fractured surfaces without the 
interposition of pieces of muscle, connective tissue or an ex- 
cessive amount of blood-clot, immobilization for a sufficient 
length of time, sufficient blood supply to both fragments, 
sufficient innervation, absence of surface inflammation and 
constitutional causes of non-union. Asepsis is greatly to be 
desired, but bony union can occur in suppurating wounds 
by a process analogous to the healing of wounds by second 
intention. 

In what stage of inflammation is cold a valuable reme- 
dial agent? Give reasons. 

Cold is a valuable remedial agent in the beginning of in- 
flammation since it causes a contraction of the blood-vessels, 
and therefore lessens the amount of blood in the part. When 
permanently employed it dilates the vessels by paralysis of 
the muscular coat and the increased amount of blood brings 
to the part an increased quantity of leucocytes and protective 
proteids. If applied for too long a time, it lowers the vital- 
ity of the tissues, promotes stasis, and interferes with the 
ameboid action of the leucocytes. 

At what age are the best results obtained from opera- 
tions for cleft palate? Give reasons. 

The best results are obtained by operating between the 
second and third years. It is not advisable to operate upon 
infants, since they stand hemorrhage poorly, suck the stitches 
and disturb them with the tongue, and because the tissues 

(101) 



102 ORAL SURGERY. 

are delicate and friable. It should not be deferred later 
than the period indicated, as bad habits of articulation will 
be contracted and subsequent success, as gauged by the qual- 
ity of the speech, is much less likely to follow. 

Differentiate lacerated and contused wounds. 

A lacerated wound is a wound produced by a tearing of 
the tissues. 

A contused wound is a wound produced by a bruising of 
the tissues. 

In practice the distinction is not well drawn, since the 
edges of most lacerated wounds are also more or less contused. 

State the predisposing causes of lingual carcinoma. 

Age of the patient (past 40) ; any irritation, such as a 
sharp tooth, the stem of a pipe, or a badly fitting plate ; 
psoriasis and scars produced by syphilis or injury, smoking. 

What are wounds and how are they classified? 

A wound is a solution of continuity of an external or in- 
ternal surface of the body. 

Wounds are classified as follows : Incised, lacerated, con- 
tused, punctured, poisoned and gunshot. 

Give varieties of fracture of the inferior maxilla. 

Through the body of the bone in the neighborhood of the 
mental foramen, at the angle or within the vertical ramus, 
through the neck of the condyle, and at the base of the coro- 
noid process. 

Describe the operation for ligating the facial artery. 

After all aseptic precautions have been carried out, a hori- 
zontal incision, one inch in length, is made directly over the 
vessel as it crosses the lower border of the jaw immediately 
in front of the masseter. The incision divides the integu- 
ment, the fascia, and the platysma myoides. In making the 
incision, the skin should be drawn upward over the bone, so 
that when the skin retracts, the scar will not be visible upon 



ORAL SURGERY. 103 

the face. The vessel is ligated just as it emerges from the 
substance of the submaxillary gland. The aneurism needle is 
passed from behind forward. 

What is anesthesia? 

Anesthesia is a condition of total or partial insensibility, 
particularly to touch. 

Define synovitis. Give symptoms and treatment. 

By synovitis is meant the inflammation of a synovial mem- 
brane. 

Symptoms. — The joint becomes the seat of lancinating pain 
and is filled with fluid. If the articulation is superficial, the 
overlying skin may be hot and hyperemic. There is a spasm 
of the surrounding muscles, causing the joint to be held in 
that position which affords the greatest ease to the patient. 
In some cases the muscles controlling the joint undergo a 
rapid atrophy. If suppuration occurs, the overlying integu- 
ment becomes dusky red and edematous. The pain becomes 
throbbing in character, and the individual is frequently 
awakened at night by starting pains in the extremity. The 
temperature is high and there is emaciation. 

Treatment. — Immobilization. In the early stages and in 
young people, cold is of value (evaporating lotions, ice-bag, 
Leiter's tubes). Later on, warm fomentations may be used 
or a few leeches applied. If painful distention is present, 
some of the fluid may be aspirated under strict aseptic 
precautions. Should suppuration occur, the joint must be 
opened, irrigated, and a rubber drainage-tube introduced into 
the most dependent portion. 

Any underlying diathesis should receive appropriate con- 
stitutional treatment. 

Describe the operation for ligating the temporal artery. 

Make a vertical incision one inch in length, a half inch in 
front of the tragus, and just above the zygomatic arch. 
Divide skin, superficial fascia and deep fascia, and then feel 



104 ORAL SURGERY. 

for the pulsation of the vessel. The aneurism needle is to 
be passed from behind forward so as to avoid the temporal 
vein and the aurieulo-temporal nerve. 

Give the varieties of gangrene. 

1. Symptomatic gangrene: embolic, senile, diabetic, Ray- 
naud's disease, ergotic. 

2. Traumatic gangrene : direct and indirect. 

3. Infective gangrene : acute rapidly spreading gangrene, 
hospital gangrene, necrosis of bone, noma or cancrum oris, 
carbuncle and boil. 

4. Thermal gangrene: frost-bite, burns, and scalds. 

Name the different methods for arresting arterial hem» 
orrhage. 

Direct pressure, acupressure, forcipressure, torsion, cauter- 
ization, and ligation. 

Is necrosis found more frequently in the inferior or in 
the superior maxilla? Why? 

Necrosis is found rather more frequently in the inferior 
maxilla because its blood supply is not so abundant. 

Differentiate a syphilitic ulcer of the tongue from a 
traumatic ulcer of the tongue. 

Syphilitic ulcer. — There is a superficial crack or fissure 
upon the side or tip of the tongue. Such fissures may be 
multiple, chronic, or relapsing. It is common in the secon- 
dary period of the disease, and is often accompanied by 
mucous patches, by similar ulcers upon the cheeks, or by 
papillar eruptions upon the skin. It improves under specific 
treatment. 

Traumatic ulcer. — The ulcer is usually situated upon the 
side of the tongue, is ragged or irregular in outline, and is 
usually opposite a collection of tartar, an angle of a tooth, 
or the edge of a plate. The glands are not enlarged. Re- 
covery follows the removal of the local irritant. 



ORAL SURGERY. 105 

Define orthodontia. 

By orthodontia is meant the correction of irregularities of 
the teeth. 

State the best method of sterilizing instruments. 

The best method of sterilizing instruments is to boil them 
for ten minutes in a 1% solution of sodium carbonate. 

What are the causes of secondary hemorrhage? 

Chief cause: Septic arteritis. 

Contributory causes : 1. Early absorption of ligature. 2. 
Faulty application of ligature. 3. Ligature too near a col- 
lateral branch. 4. A diseased condition of the arterial wall. 
5. A state of blood unfavorable to repair of any wound 
(albuminuria or diabetes). 6. Increased blood pressure 
(plethora, Bright 's disease, fever, injudicious excitement, or 
unwise administration of stimulants) . 

Define staphylorrhaphy. State the most favorable age 
for the operation. 

By staphylorrhaphy is meant the plastic operation for clos- 
ing a cleft in the soft palate. 

The most favorable age for the performance of the opera- 
tion is between the second and third year. It is very im- 
portant that staphylorraphy should be performed before the 
child commences to talk. 

Mention two methods of preserving the aseptic char- 
acter of a wound. 

The aseptic method and the antiseptic method. 
Give etiology and treatment of syncope. 

Syncope is due to anemia of the brain produced by sudden 
failure of the heart's action. 

Lay patient flat on his back with the head low. Make 
friction over the prascordial region or apply galvanism. 
Apply smelling salts to nostrils and give a little brandy as 
soon as the patient can swallow. 



106 ORAL SURGERY. 

Give the clinical appearance and treatment of osteoma 
of the inferior maxilla. 

Osteoma of the inferior maxilla may consist either of a 
general thickening or enlargement of the entire bone or of a 
local outgrowth. The tumor is extremely hard, grows slowly, 
and causes no pain unless it presses upon important sensory 
nerves. The neighboring lymphatic glands are not enlarged. 

Treatment. — These tumors are best left alone unless the 
deformity is great or the movements of the mandible are in- 
terfered with. They may be partially excised, the offending 
portions being chiselled, drilled, or ground away, or they may 
be wholly removed by excising a portion of the mandible. 

Describe suppurative cellulitis. 

The affected part is hot, tender, and infiltrated; if super- 
ficial, it looks red and angry and is brawny to the touch. 
Fever is usually present and, in severe eases, one or more 
rigors may occur. If the part is not incised, the process 
rapidly spreads throughout the entire extremity or region; 
the toxic fever rapidly exhatists the patient's strength and 
the entire subcutaneous and intermuscular areolar tissue of 
the part is destroyed. 

Define surgical shock. Give the treatment. 

Surgical shock is the immediate constitutional effect of an 
injury. 

Treatment. — When slight, rest in the recumbent posture 
and the use of some aromatic stimulant (ammonia). If 
severe, recumbent position with the head low; surround the 
patient with hot bottles (well protected) and blankets to 
maintain and bring up body-temperature. If conscious and 
able to swallow, give a little warm tea or stimulant; if un- 
conscious, a small hot coffee or brandy enema, or a hypoder- 
matic injection of ether or strychnine. Care should be taken 
not to waste vital power by over-stimulation Avhich will result 
in excessive reaction. The intravenous injection of normal 
saline solution frequently gives excellent results. If the 



ORAL SURGERY. 107 

shock is maintained by the presence of a mangled limb, it 
may be well to perform an amputation. 

What diseases of the tongue may be mistaken for car- 
cinoma? 

Primary, secondary, or tertiary syphilis, leukoplakia, 
chronic glossitis, traumatic ulcers, tubercular ulcers, sarcoma, 
and actinomycosis. 

Mention two varieties of cysts of the tongue. Give the 
treatment of one variety. 

Dermoid cyst. — ^Retention cyst, due to the occlusion of the 
duct of a small mucous gland. 

The retention cyst is best treated by excision. 

Mention the materials employed for sutures, and de= 
scribe the twisted or hare=Iip suture. 

Silk, silkworm-gut, catgut, kangaroo tendon, silver wire, 
and horse-hair. 

The hair-lip or twisted suture consists of metallic pins or 
needles thrust through both lips of the wound, the edges of 
which are kept in contact over the pins by figure-eight turns 
of silk. 

Give the etiology, clinical appearance, and the treat= 
ment of acute ranula. 

Acute ranula is an accumulation of saliva (from obstruc- 
tion and rupture of "Wharton's duct) in a serous sac known 
as Fleischmann 's bursa (Tillaux). Duplay considers the 
acute ranula to consist of a dilation of the duct itself. 

The cystic tumor is situated in the floor of the mouth to 
one side of the median line. It is globular, semi-transparent, 
and may attain the size of a bantam's egg, pushing the 
tongue upwards and backwards and interfering with deglu- 
tition and speech. It contains a glairy mucous fluid. 

Treatment. — Excision of a portion of the anterior wall of 
the cyst and swabbing out the cavity with pure carbolic acid. 
The cavity is then packed with iodoform gauze and made to 



108 ORAL SURGERY. 

heal by granulation. If the condition recurs, the entire 
growth is to be excised. 

Mention the varieties of displacement in fracture of 
the inferior maxilla. Give the symptoms and treatment 
of one variety. 

In fractures through the angle, or lower part of the ramus, 
there is usually little displacement, as the masseter on the 
outer side and the internal pterygoid on the inner side, main- 
tain the fragments in apposition. When the fracture passes 
through the neck of the condyle, that process is drawn for- 
ward and inward by the external pterygoid, whilst the body 
of the bone is freely movable antero-posteriorly, and is dis- 
placed toward the sound side. 

When the coronoid process is detached, it is drawn up- 
wards by the temporal tendon, but no great displacement 
can occur, owing to the extensive attachment of the tendinous 
fibres. 

In the most common fracture, through the body of the bone 
near the mental foramen, the large anterior fragment is dis- 
placed downwards by the muscles passing from the hyoid 
bone to the jaw. The smaller fragment is drawn upwards 
by the muscles of mastication and is displaced outwards, so. 
that it overlaps the anterior fragment. 

In a fracture through the body of the jaw there will usually 
be hemorrhage from the mouth, irregularity of the denture, 
crepitus, and a displacement as described above. The treat- 
ment consists of the reduction of the displacement, the appli- 
cation of a Barton bandage and the maintenance of an aseptic 
condition of the oral cavity. If necessary, Hammond's splint 
may be applied. 

Define neurasthenia and give its symptoms and treat- 
ment. 

A condition of lack of power of the nerve-centers, not de- 
pendent upon the existence of organic disease in any portion 
of the body. 



ORAL SURGERY. 109 

Symptoms. — Loss of weight and slight anemia, excessive 
irritability of the heart, spots of local tenderness over the 
spine, weariness upon exertion, weakness of memory, disturb- 
ance of sleep, flushes of heat, profuse sweating, and occasion- 
ally disturbances of sensation. 

Treatment. — Rest, with change of scene and diet; massage, 
out-of-door life, avoidance of excitement, strychnine in full 
doses, and, best of all, the "rest cure" as prescribed by Dr. 
S. Weir Mitchell. 

Define odontoma. Give the classification, clinical ap- 
pearance, and the treatment of odontoma. 

An odontoma is a tumor originating from some abnormal 
condition of the teeth or teeth germs. 

1. Epithelial odontoma. Originates from enamel organs, 
usually affects lower jaw, forms tumor of great size, and as 
a rule runs a perfectly benign course. The only treatment 
consists in complete removal of the affected portion of the jaw. 

2. Follicular odontoma (dentigerous cysts). More com- 
mon in lower jaw, tumor, at first, hard and solid, but sub- 
sequently gives egg-shell crackling and even fluctuation. A 
permanent tooth will be found missing, and there is no his- 
tory of its having been extracted. The treatment consists in 
excising a portion of the wall of the cyst from the mouth 
and extracting the misplaced tooth. ' The interior of the cyst 
is then to be thoroughly scraped, flushed with an antiseptic 
solution and packed with gauze. 

3. Fibrous odontoma. Occurs rarely in rickety children ; 
there is thickening and condensation of the connective tissues 
around a tooth-sac. Treatment, thorough removal. 

4. Radicular odontoma. A tumor composed of cement de- 
veloping at the root of a tooth. It causes severe pain and 
may result in septic inflammation of the surrounding bone. 
Treatment, thorough removal. 

5. Composite odontoma. These may be very large and re- 
semble osteomata of the antrum. Treatment, thorough re- 
moval if causing trouble. 



110 ORAL SURGERY. 

Give the etiology, clinical division, pathologic classifi- 
cation, and the treatment of tumors. 

Etiology. — Injury or irritation, infection, heredity, fetal 
residues. 

Clinical Division. Benign and Malignant. 

Pathologic Classification. 

I. Mesoblastic or Connective Tissue Tumors. 

A. Those conforming to the types of fully formed con- 
nective tissues: 

1. Fibroma. 

2. Lipoma. 

3. Chondroma. 

4. Osteoma. 

5. Myxoma. 

B. Those conforming to the types of the higher connective 
tissues : 

1. Myoma. 

2. Angioma. 

3. Lymphangioma. 

4. Neuroma. 

C. Those conforming to the types of embryonic connective 
tissue : Sarcoma. 

II. Epiblastic and hypoblastic tumors, i. e., those conform- 
ing to the type of Epithelial Tissues: 

1. Papilloma. 

2. Adenoma. 

3. Carcinoma. 

III. Tumors composed of Epiblastic, Hypoblastic and 
Mesoblastic Elements: Teratoma. 

Treatment. — In Benign Tumors, removal if annoying or if 
they show a tendency to become malignant. 

In Malignant Tumors, secondary deposits should be re- 
moved with the primary growths. If complete removal is 
impossible they had best be left alone. 



ORAL SURGERY. Ill 

Give the causes and treatment of spasmodic respiratory 
failure. 

Laryngitis, laryngismus stridulus, tetanus, and hydro- 
phobia. 

Treatment. — In tetanus and hydrophobia treatment is prac- 
tically useless. It consists of the administration of chloral 
between, and of chloroform during the attacks. 

In laryngitis and laryngismus stridulus, place child in hot 
bath. Give syrup of ipecac to produce vomiting and place 
hot compresses about the throat. If child cannot swallow, 
tickle throat with finger to produce emesis. 

Describe the operation of extracting molar teeth. Men- 
tion accidents that may occur in the extraction of these 
teeth. 

First and second upper molars. The operator stands at 
right of patient, passing the left arm around the head, and 
holding the lip out of place with the fingers of the left hand. 
In using the cow-horn forceps, take care to thrust the points 
of the horn directly into the interspace and then carry the 
flat blade along the palatine fang as high as possible. A few 
rocks of the tooth inward and outward combined with direct 
force in the line of its long axis will cause it to give way. 

First and second lower molars. Position of operator as 
before. Use the cow-horn forceps for lower molars, and so 
apply them that the closure of the handle forces the points 
into the interspace where they will meet. If closing the 
handle does not loosen the tooth, gently rock the forceps in- 
ward and outward until the tooth is felt to yield, when it is 
at once to be lifted from its socket. 

In extracting the third molar, an appropriate forceps must 
be selected and the traction made in the axis of the single 
curved root, usually backwards and upwards or downwards, 
as the case may be. 

The accidents of extraction are: Laceration of gum, frac- 
ture of alveolar process, paralysis, excessive hemorrhage, 



112 ORAL SURGERY. 

loosening or breaking of other teeth, and luxation of the in- 
ferior maxilla. 

Define replantation of teeth, transplantation of teeth, 
and implantation of teeth. 

By replantation is meant the return of a tooth to its nat- 
ural socket after extraction. 

By transplantation is meant the transference of a tooth 
from its original socket to one existing in another jaw. 

By implantation is meant making a socket in a jaw where 
none exists and inserting a tooth into it. 

Give a differential diagnosis of traumatic ulcer of the 
tongue and epithelioma of the tongue. 

The traumatic ulcer is usually situated upon the side of 
the tongue opposite a mass of tartar, an angle of a tooth, or 
the edge of a plate. The ulcer is ragged, irregular, without 
induration (unless very chronic) and the lymphatic glands 
beneath the lower jaw are not enlarged. 

Epithelioma occurs in middle-aged or elderly individuals. 
The ulcer has a widely indurated base, thick everted edge, an 
irregular warty surface, a watery discharge, and there is an 
enlargement of one or more of the submental glands. 

Give a differential diagnosis of suppuration of the max- 
illary sinus and tumor of the maxillary sinus. 

Suppuration. Tumor. 

History of preceding alveolar ab- No such history, 
scess or rhinitis. 

Causes same deformity, but to a Exophthalmos, encroachment upon 
less degree. nasal fossae, a flattening of roof 

of mouth, and a projection of 
the cheek below the malar bone. 

Intermittent discharge of pus from No suppuration, 
nostril of affected side. 

Fever. No fever. 



ORAL SURGERY. 113 

If acute, the cheek is red, hot, and May be painful or painless, 
swollen, and the part is painful. 

Exploratory puncture reveals pus. Exploratory puncture does not re- 

veal pus. It may reveal blood 
(sarcoma), or exploratory punc- 
ture may be impossible (oste- 
oma). 

Give the etiology, diagnosis, and treatment of cystic 
dilatation of Steno's duct or of Wharton's duct. 

Etiology. - — A salivary calculus may be formed within 
Steno's duct and completely occlude its lumen. 

Diagnosis: Painful swelling in region of parotid gland, 
pain increased by the ingestion of food. The calculus may 
be readily detected by probing the duct, or it may be felt 
through the tissues of the cheek. 

Treatment. — Remove the calculus by an incision into the 
overlying buccal mucous membrane. 

State how syncope spontaneously arrests hemorrhage. 

By reducing the force of the blood current and thus permit- 
ting coagulation to occur within the wounded vessel. 

Describe the Hammond wire splint and state in what 
class of fractures it can be successfully employed. 

It consists of a firm wire collar or framework which en- 
circles the whole series of teeth in the lower jaw. It is ac- 
curately fitted to the jaw and fixed by several short wires 
passing from the lingual to the buccal wire between the teeth. 

It can be successfully employed in a fractured mandible 
where there is much displacement. 

Define fracture. Give the local and the constitutional 
causes of non=union of fractures. 

A fracture is a sudden solution of continuity in a bone, 
usually due to excessive violence. The local causes of non- 
union are: 

1. Faulty apposition. 

8 



114 ORAL SURGERY. 

2. The interposition of fluid, muscular or aponeurotic tissue, 

or pieces of bone between the ends of the fragments. 

3. Want of rest. 

4. Defective blood supply. 

5. Defective innervation. 

6. Inflammation on the surface of the limb. 

7. Faulty treatment, and, 

8. Local affection of bone (malignant tumors, destruction 

of the periosteum by inflammation). 
The constitutional causes are : 

1. General constitutional weakness. 

2. Osteomalacia. 

3. Scurvy. 

4. Syphilis. 

5. Senility (probably). 

6. Pregnancy, and 

7. The cancerous cachexia. 

Differentiate sapremia, septicemia and pyemia. 

Sapremia (septic intoxication) is a wound fever due to the 
absorption of the products of putrefaction into the system. 
It is a toxemia or condition due to chemical poisoning, and 
the blood is not infective. 

Septicemia (septic infection) is a wound fever due to the 
introduction into the blood and tissues of bacteria, which 
rapidly multiply. The blood is infective, since it contains not 
only the toxins but also the organisms which produce them. 

Pyemia is a wound fever developed during the process of 
suppuration, and is due to the absorption of pyogenic organ- 
isms into the circulation. Clinically, pyemia is septicemia 
plus metastatic abscesses. 

State precautions that should be taken when operating 
on syphilitic patients. 

Any cracks or abrasions upon the hands of the operator 
should be protected by a collodion dressing and the hands 
should be encased in a pair of sterile rubber gloves. At 



ORAL SURGERY. 115 

various intervals during the operation, the hands should be 
immersed in an antiseptic solution and then rinsed in sterile 
water. At the conclusion of the operation the hands should 
be well scrubbed, soaked for several minutes in a bichloride 
of mercury solution (1-1000), and then washed in sterile 
water. 

In trifacial neuralgia caused by infection, malaria, or 
grip, what division of the nerve is usually involved? 

The first or ophthalmic division. 

What produces mechanical asphyxia during ether or 
chloroform anesthesia? 

Mechanical asphyxia is produced by the tongue falling 
backward over the glottis. 

Give the differential diagnosis of fracture and dislo- 
cation. 

Fracture. Dislocation. 

Preternatural mobility. Immobility. 

Crepitus. No crepitus. 

The deformity usually returns im- The deformity does not usually re- 
mediately after it has been cor- cur after it has been corrected, 

rected. 

Give the anatomical and the clinical varieties of hemor- 
rhage. 

The anatomic varieties of hemorrhage are the arterial, the 
venous, and the capillary. 

The clinical varieties of hemorrhage are primary hemor- 
rhage, intermediate or reactionary hemorrhage, and secondary 
hemorrhage. 

State why an alveolar abscess may cause suppurative 
inflammation of the maxillary sinus. 

Because the suppuration is in the floor of the sinus and 
may point towards its cavity or cause a suppurative inflam- 
mation by contiguity of structure. 



116 ORAL SURGERY. 

Mention the predisposing and the exciting causes, to- 
gether with the local and the constitutional symptoms of 
inflammation. 

The predisposing causes include everything which lowers 
the general resistance of the body; such as Bright 's disease, 
diabetes, anemia, tuberculosis, and chronic alcoholism. 

The exciting causes are traumatism, heat, cold, chemical 
agents, and bacteria. 

The local symptoms are redness, heat, pain, swelling, and 
modified function. The constitutional symptom is fever. 

Give the pathology, symptoms and treatment of inflam- 
mation. 

Pathology. — There are three sets of changes: 

1. Changes in the blood-vessels and in the circulation. The 
blood-vessels dilate. The current is at first more rapid but 
soon becomes slower, so that an axial stream (red blood cor- 
puscles) and a periaxial stream (white blood corpuscles and 
blood placques) may be differentiated. In addition to dilat- 
ing, the vessels become elongated and tortuous. The current 
finally becomes so sluggish that it moves onward with each 
systole and backward with each diastole (oscillation). This 
is followed by stasis. 

2. Exudation of serum and transmigration of the leuco- 
cytes. 

3. Changes in the tissues themselves. These consist of a 
multiplication of the fixed and wandering connective tissue 
cells. 

Symptoms. — The local symptoms are redness, heat, pain, 
swelling, and modified function. The constitutional symp- 
tom is fever. 

Treatment. — The local treatment includes rest, elevation, 
the use of heat or cold, local blood-letting, astringents, anti- 
septics, counter-irritation, compression, and massage. 

The constitutional treatment comprises good hygiene, a 
light nutritious diet, purgatives, venesection, antipyretics,, 
hypnotics, analgesics, stimulants, and tonics. 



ORAL SURGERY. 117 

Give the cause and treatment of noisy movements of the 
temporo=maxillary articulation. 

Cause. — Laxity of ligaments and weakness of surrounding 
muscles. In some cases it is due to a displacement of the 
inter-articular cartilage. 

Treatment. — Tonics, electricity. The wearing of an occi- 
pito-mental sling. If the inter-articular cartilage is displaced 
an incision may be made into the joint and the cartilage 
sutured in its normal position. 

Define septic intoxication. Give treatment. 

Septic intoxication is a form of poisoning resulting from 
the absorption of the products of putrefaction. 

The local treatment consists of the thorough removal of the 
source of infection and of the antiseptic treatment of the 
wound. 

The constitutional treatment must be of a supporting char- 
acter. Alcohol and hypodermatic injections of strychnine are 
to be recommended. Enteroclysis or hypodermoclysis. 

Define stomatitis. Mention the varieties of stomatitis 
and give treatment of one variety. 

By stomatitis is meant an inflammation of the oral mucous 
membrane. 

The varieties are catarrhal, aphthous, ulcerative, parasitic, 
gangrenous, mercurial, syphilitic, and scorbutic. 

Treatment of ulcerative stomatitis : Correct the hygiene. 
Tonic doses of quinine. Touch ulcers with nitrate of silver. 
Use as a mouth wash a solution of potassium chlorate or 
hydrogen peroxide. 

Differentiate acquired cleft palate and congenital cleft 
palate. 

Congenital cleft palate exists at birth and is due to want of 
union of the two palatal segments of the maxillary processes. 

Acquired cleft palate is produced at some period of extra- 
uterine life by loses of substance resulting from injury or 
syphilis. 



118 ORAL SURGERY. 

How would you treat persistent bleeding after lancing 
the gums of a child? 

By pressure with compresses soaked in peroxide of hydro- 
gen ; by packing the incision with a pledget of cotton satur- 
ated with phenate of soda or a solution of tannic acid. In 
some cases the lips of the wound may be temporarily approx- 
imated by a suture. Monsel's salts and solutions are only to 
be used in extreme cases, since they impair the vitality of the 
tissues and increase the danger of secondary hemorrhage. 
In addition to the local treatment, one of the following hemos- 
tatics may be administered : 

Tr. ergot (gtt. V, repeated in one or two hours), Tr. erig- 
eron canadensis (gtt. 1, in water every minute until bleeding 
ceases, or until twenty doses have been taken) , gallic acid 
(gr. 1, every two hours). 

What treatment would you pursue in excessive hemor- 
rhage after tooth extraction? 

Remove all clots and pieces of root, plug the tooth-socket 
with a strip of gauze saturated with peroxide of hydrogen, 
and reinforce the plug by means of a supporting pad. 
Should this fail, a plug may be made of gauze, the meshes 
of which contain tannic acid or alum. The advantage of the 
clot formed by tannin is that it is insoluble in the blood. 
Perchlorid of iron and Monsel's solution should not be em- 
ployed on account of their injurious effects upon the tissues 
and the danger of secondary hemorrhage. In obstinate cases, 
the hemorrhage may always be controlled by packing the 
tootb-socket with a strip of gauze, in the meshes of which 
rapidly-setting plaster of Paris has been incorporated. A 
pledget of cotton saturated with adrenalin chloride (1-1000) 
may also be used. 

Give one of the causes of antral disease, its diagnosis, 
and treatment. 

An alveolo-dental abscess discharging into the antrum. 
The diagnosis will be made by the presence of the follow- 



ORAL SURGERY. 119 

ing signs and symptoms : Pain over the affected region and 
the discovery of the offending tooth or root. Tenderness 
upon percussion of the antrum. The escape of pus through 
the nostril of the affected side. If the antrum contains a con- 
siderable quantity of pus, it will be opaque to transmitted 
light, as compared with the opposite side. The examination is 
made by taking the patient into a dark room and introducing 
a small incandescent lamp into the mouth, which is then 
closed. If the pus can find no outlet, the floor of the orbit 
will be pushed up, causing exophthalmos, the nasal fossae will 
be encroached upon, and there will be edema of the cheek. 

The treatment consists in the establishment of efficient 
drainage and the thorough irrigation of the cavity of the 
antrum. This may be accomplished by extracting the offend- 
ing tooth or root and enlarging the opening into the antrum. 
The antrum may also be entered above the root of the second 
bicuspid tooth, about one inch above the border of the gum. 
The opening into the antrum must be kept open by a gauze 
or tubular drain until the discharge entirely ceases. During 
this time the cavity of the antrum may be irrigated — at first 
daily, and subsequently at longer intervals. 

How would you treat a case of external fistula with 
adhesion from an alveolar abscess? 

The entire fistulous tract must be dissected out and all 
cicatricial tissue removed. The necrotic bone must be burred 
away until healthy bone is reached. After the hemorrhage 
has been arrested the adjacent skin is to be loosened up 
and a flap slid over the site of the bone lesion, so that the 
cutaneous wound shall not directly overlie the wound in the 
bone. 

How would you diagnose and treat hypertrophy of the 
gums, and in what class of persons, as to age and mental- 
ity, does it occur? 

Diagnosis. — Diffuse, spongy, bleeding overgrowth of gums. 
Teeth show that they have been greatly neglected and are 



120 ORAL SURGERY. 

covered with accumulated deposits. The affection occurs 
after second dentition, usually between the ages of 18 and 
25, in those who are ignorant and careless in their personal 
hygiene. 

Treatment. — Remove all deposits. Clean teeth. Give anti- 
septic mouth washes. Instruct in care of mouth, and, if 
necessary, leech, incise, or excise redundant tissue, or galvano- 
cautery may be used. 

How would you treat luxation of the inferior maxilla? 
Describe the lesion and treatment anatomically. 

The mechanism is as follows : When the mouth is opened 
the condyle slides forward upon the eminentia articularis 
and only a slight traumatism is necessary to displace it still 
further forward into the zygomatic fossa. The inter-articular 
cartilage may or may not follow the condyle. 

The luxation may be unilateral or bilateral, more fre- 
quently the latter. The mouth cannot be closed and the 
lower jaw projects anteriorly beyond its normal position. A 
hollow may be felt just in front of the tragus, in the position 
normally occupied by the condyle. The condyle may be felt 
in front of this hollow. If the finger is inserted into the 
mouth, the coronoid process may be felt in an abnormal posi- 
tion beneath the zygoma. If the dislocation is unilateral, 
the symptoms are less marked, the jaw is more mobile, and 
the chin is displaced towards the sound side. 

Treatment. — All that is needed is to depress the condyle 
below the level of the eminentia articularis, when the mas- 
seter, temporal and internal pterygoid muscles readily draw 
it back into the glenoid cavity. The patient is to be seated 
in a chair; the surgeon stands in front of the patient and 
presses downward upon the molar teeth with his thumbs, 
which are guarded with a towel. This pressure is continued 
in a downward and backward direction until the condyle 
clears the eminentia articularis, when the chin is raised by 
the fingers. The jaw is then to be kept at rest for four or 
five days by a Barton bandage. 



ORAL SURGERY. 121 

Give briefly your method of procedure in the treatment 
of a compound fracture of the inferior maxilla. 

The mouth, or the external wound, is to be kept as aseptic 
as possible. In ordinary cases, an external moulded splint 
may be applied to the chin, and the lower jaw held against 
the upper one by means of a Barton or a four-tailed bandage. 

The fragments may be held in place by a wire collar en- 
circling all of the teeth of the lower jaw. This collar is to 
be accurately fitted, first to a cast of the jaw and then to the 
jaw itself, and fixed by several wires passing from one half 
to the other, between the teeth. 

If the teeth are defective, Kingley's splint may be em- 
ployed. This consists of a vulcanite splint fitted over the 
alveolar process. Curved metal bars are attached to the front 
of the splint and extend backward over the cheeks from the 
angles of the mouth. The splint is kept in position by a 
bandage passing over the bars and under the chin. This 
splint will immobilize the fragments, even when the mouth 
is opened. 

In obstinate cases the fragments may be wired. 

Give the diagnosis and treatment of a dentigerous cyst. 

Diagnosis : These cysts are usually encountered in young 
individuals, but may occur in later life. They are far more 
common in the lower than in the upper jaw. At first the 
tumor is hard and solid, but as the bone expands it becomes 
thinned, and palpation reveals egg-shell crackling or even 
fluctuation. Upon examination of the denture, one of the 
teeth will be missing and there will be no history of its ex- 
traction. 

Treatment. — Excise a portion of the wall of the cyst 
(through the mouth) and extract the misplaced tooth. The 
interior of the cyst should then be scraped, irrigated, and 
packed with iodoform gauze. 

How would you diagnose and treat epulic tumors? 

Diagnosis. — Benign or fibrous epulis appears as a red, 



122 ORAL SURGERY. 

fleshy mass, smooth or lobulated^ elastic to the touch and 
probably showing some superficial ulceration. It is a pain- 
less tumor of slow growth. 

Malignant or myeloid epulis forms a soft, rapidly growing, 
painful tumor, dusky red in color, and soon ulcerating. 

Treatment. — The best treatment for fibrous epulis is to re- 
move the growth, together with that portion of the alveolus 
from which it takes its origin. If necessary, a tooth on 
either side of the tumor must be extracted, each socket cut 
through vertically with a saw, and the incisions united below 
with a chisel. In this manner, a quadrangular piece of the 
alveolus is removed without interfering with the continuity 
of the jaw. 

In malignant epulis, it is necessary to operate as early as 
possible and to carry the bone incision quite wide of the mar- 
gin of the tumor. If the tumor is large, it may be necessary 
to remove the entire thickness of the lower, or the palatal 
segment of the upper jaw, as the case may be. 

What is a ranula? 

A ranula is a retention cyst, due to the obstruction and 
dilatation of one of the ducts of the sublingual or submaxil- 
lary gland. 

What do you know about aphthae and their treatment? 

The term "aphthae" is an old one and includes aphthous 
stomatitis, ulcerative stomatitis, thrush, and cancrum oris. 

Aphthous stomatitis. — Seen in nursing children. Inspec- 
tion reveals numerous small round vesicles on the cheek, lips, 
and tongue; the vesicles soon break, leaving shallow ulcers 
with a red areola. 

Treatment. — Sterilize the milk. Correct any gastric dis- 
turbance. Use a mouth wash of boric acid. 

Ulcerative stomatitis. — Attacks children and adults when in 
poor health or subjected to bad hygienic surroundings. In- 
spection reveals linear ulcers with gray sloughing bases. The 



ORAL SURGERY. 123 

submaxillary glands are swollen. In severe cases, loosening 
of teeth and necrosis of bone may follow. 

Treatment. — Correct hygiene. Tonic doses of quinine. 
Touch ulcers with nitrate of silver. Use as a mouth wash a 
solution of potassium chlorate or hydrogen peroxide. 

Parasitic stomatitis (Thrush). Inspection reveals numer- 
ous white elevations, which on removal leave a raw surface. 
Microscopic examination reveals the saccharomyces albicans. 

Treatment, — Correct the hygiene. Treat any gastric dis- 
turbance. Tonics. Some antiseptic ruouth wash, such as 
solutions of borax, boric acid, or hydrogen peroxide. 

Gangrenous stomatitis (Cancrum oris). — Usually seen in 
debilitated children and after one of the specific fevers, par- 
ticularly measles and whooping-cough. The cheek is the part 
affected. Externally, it is swollen, hard, red, and glazed ; 
internally, an irregular sloughing ulcer is noted. 

Treatment. — Good hygiene and stimulants. Chloroform 
the child and excise the gangrenous area, cutting widely 
into healthy tissue. The edges of the wound are then cauter- 
ized with fuming nitric acid, bromine, or the actual cautery. 
The resulting deformity must be treated later by a plastic 
operation. 

Describe trismus and how it differs from tetanus. 

Trismus simply means a spasmodic locking of the jaws. 
It may have its cause in associated dental lesions, causing 
irritation of the nerves of the part; it is also a symptom of 
tetanus. 

Tetanus is an acute infectious disease, due to the bacillus 
of tetanus and characterized by tonic spasms with clonic ex- 
acerbations. The spasms also affect the muscles of the trunk. 

What is a traumatic lesion? 

A traumatic lesion is a solution of continuity due to injury. 

By what surgical operation would you abort an impend- 
ing alveolar abscess? 

Make a slight cut with a sharp scalpel through the soft 



124 ORAL SURGERY. 

parts of the apex of the affected tooth. Pierce the outer 
plate of hone with a spear-pointed drill, thus entering the 
region in which the suppuration is impending. This wound 
should be kept patulous for several days. 

What are the indications for the use of the lance in de- 
ciduous dentition? 

The lance should never be used until the appearance of the 
white line, which is due to the pressure exerted by the erup- 
ting tooth. Lancing should never be performed unless re- 
flex disturbances are produced. 

What anatomical irregularity of the inferior third molar 
tooth frequently presents itself in extraction? Anticipat- 
ing this condition, how would you extract it? 

The roots of the inferior third molar are almost always 
fused and curve backward. This throws the tooth against 
the second molar. Always endeavor to determine the course 
of the root, and then make traction in a corresponding direc- 
tion, usually upwards and backwards. 

Name some of the forms of sutures employed in the 
closing of surgical wounds, and what substances are used? 

The interrupted, the continuous, the mattress, the quilled, 
and the shotted suture. 

The materials employed are silk, silkworm-gut, cat-gut, 
kangaroo tendon, and silver wire. 

What is torsion, and when is it preferable to other 
means in arresting hemorrhage? 

By torsion is meant the twisting of an artery until its 
middle and internal coats are lacerated. 

It is preferable to other means in plastic operations, where 
it is not considered desirable to leave too many ligatures 
behind. It is also preferable where aseptic ligatures cannot 
be obtained. 

When it is surgically necessary to make an incision 
through a muscle and a choice exists for carrying the in- 



ORAL SURGERY. 125 

cision parallel or transverse to the fibres of the muscle, 
which way would you adopt, and why? 

Make the incision in the direction of the fibres. The reason 
for this is that fewer fibres will be severed and the function 
of the muscle will be practically unimpaired. 

What is a sequestrum? 

A sequestrum is a piece of dead bone resulting from 
necrosis. 

At what point is the trunk of the facial nerve most liable 
to injury? If severed, what change occurs? 

At its exit from the stylo-mastoid foramen. If severed, a 
paralysis of the muscles of expression of the affected side is 
produced. The folds and wrinkles are obliterated upon the 
paralyzed side. The eyelid cannot be completely closed. On 
attempting to laugh or show the teeth, the muscles of the non- 
paralyzed side alone are contracted, and marked asymmetry 
results from the drawing over of the opposite side. The lips 
cannot be closed firmly, and whistling is impossible. Food 
collects between the cheek and the teeth, owing to the paral- 
ysis of the buccinator muscle. 

What is hare=lip? Describe a remedial operation and 
give the best age for its performance. 

A hare-lip is a congenital fissure of the upper lip, which 
may extend for a variable distance through the tissues. 

Rose's Operation. The incision extends from the apex of 
the cleft, or from within the nostril, in a concentric manner 
so that a slight angular projection is formed to constitute a 
prolabium. This is done on each side and, where the nose 
is much flattened, more tissue is removed from the outer than 
from the inner side, so that when the parts are sutured to- 
gether, the nostrils become as nearly symmetrical as possible. 
By this means the depth of the lip is increased to allow of 
subsequent contraction ; the vermilion borders must be accu- 
rately approximated. Two deep silkworm-gut sutures should 



126 ORAL SURGERY. 

be introduced, one just above the red margin and one close 
to the nose. Cat-gut sutures are used to bring the margins 
of the wound together accurately. The dressing consists of 
gauze and collodion. The gauze is cut in the shape of a 
paddle, the broad ends being fastened to the cheek. This 
should be so applied as to prevent tension upon the wound. 
The silkworm-gut sutures are removed upon the fourth day. 
The best age for the performance of the operation is from 
six weeks to three months. 

Define ankylosis. Give an example. 

Ankylosis is a condition of partial or complete immobility 
of a joint, resulting from some preceding inflammation of the 
articular structures. As an example might be given that 
form which is seen in the elbow joint after fractures into the 
articulation, and the subsequent period of enforced rest. 

How are fractures classified? 

Simple. — Not communicating with the external air. 

Compound. — Communicating with the external air. 

Comminuted. — A number of small fractures. 

Complicated. — Associated with a dislocation or with a lacer- 
ation of the main arterial or nervous trunk. 

Fractures are also divided into complete and incomplete. 

According to the line of fracture, they are called longitu- 
dinal, transverse, oblique, stellate, etc. 

Describe several methods for arresting hemorrhage in 
general. 

Ligation. — Make an incision at a slight angle to the line of 
the artery. Expose the sheath.. Make as small an opening 
in the sheath as possible and pass a ligature about the vessel 
by means of an aneurysm needle. Tie the ligature tight 
enough to lacerate the inner and middle coats. 

Torsion. — Dissect the end of the artery free from the sheath 
for half an inch. Seize it transversely with a hemostatic 
forceps, and then twist the free end of the artery by means 



ORAL SURGERY. 127 

of a second hemostatic forceps until the internal and middle 
coats are lacerated. 

Arrest capillary hemorrhage by filling the wound with hot 
water (125° F.). 

Give the etiology, clinical appearance, and the treat* 
ment of spongy gums. 

Etiology. — Stomatitis, systemic derangement of any kind, 
from mild fevers to acute diseases, uncleanliness, calcareous 
deposits around the necks of teeth. 

Clinical appearance. — The gums appear swollen and flabby 
around the necks of the teeth. They have a peculiar spongy 
appearance and their margins are dotted and streaked with 
bright red spots and lines. They bleed upon the slightest 
provocation. 

Treatment. — Removal of exciting cause, cleanliness, local 
blood-letting, the use of antiseptic mouth-washes and systemic 
treatment according to condition of general health. 

Give the etiology, pathology and treatment of perice- 
mental abscesses. 

Etiology .■ — Infection from the root or from a pocket of pus 
(as in' pyorrhea alveolaris). A deposit of uric acid upon the 
root may irritate the surrounding tissues and lessen resist- 
ance to infection. 

Pathology. — The same as that of any other abscess. 

Treatment. — Secure free drainage for pus, render the ab- 
scess cavity as aseptic as possible, and prescribe an antiseptic 
mouth- wash. 

Give the etiology, clinical appearance, and treatment of 
arsenic necrosis of the alveolar process. 

Etiology. — The arsenic usually gains access to the alveolus 
from an application made to the pulp. 

Clinical appearance. — A red tumefied area in the center of 
which a slough is located. The process generally extends 
down into the alveolus and affects the septa between the teeth. 






128 ORAL SURGERY. 

Treatment. — Removal of necrotic tissue. The local appli- 
cation of sesqui-oxide of iron has been highly recommended. 
Repeated syringings and antiseptic mouth-washes. 

Give the method of removing a broken bur or nerve 
broach from a pulp canal. 

Drill around the bur with a fine fissure drill; iodine may 
be applied and the part rusted out; sulphuric acid may be 
used to remove some of the tooth structure, or an attempt 
may be made to draw out the bur with a barbed Donaldson 
broach. 

Give the causes, pathologic conditions, and the symp- 
toms of traumatic dislocation. 

Causes. — The application of external violence and muscular 
force, acting alone or in combination. 

Pathologic conditions.- — The ligaments are partially or com- 
pletely torn. In closely fitting joints (particularly hinge- 
joints, the bony surfaces are frequently fractured. The 
cartilages may be bruised or partially detached and the 
neighboring muscles and tendons lacerated or displaced. Sur- 
rounding vessels and nerves are frequently injured and the 
area involved is always infiltrated by a considerable effusion 
of blood. 

Symptoms. — Pain, brusing, and swelling of the soft tissues. 
Deformity, since the articular end of the bone is displaced 
into a new position where it may often be felt and sometimes 
seen. Restricted mobility of the affected joint. True crep- 
itus is not present unless a fracture co-exists. 

Give the diagnosis, prognosis, and treatment of moist 
gangrene of the pulp. 

Diagnosis. — If there is an outlet for the escape of the gases 
of decomposition, pain is not necessarily experienced. Ordi- 
narily, however, the condition causes more or less intense 
pain, which is usually of a throbbing and heavy character. 
If inflammation has spread to the surrounding tissues, the 



ORAL SURGERY. 129 

application of heat may cause an increased amount of pain. 
A foul-smelling odor is constantly present. 

Prognosis. — Not necessarily bad. The tooth may be saved 
in a majority of cases. 

Treatment. — Removal of all decomposed parts and pro- 
ducts, disinfection of pulp canal, hermetical sealing of apex 
of the tooth, and filling of the pulp canal. 

Give the etiology, diagnosis, and treatment of acute non= 
purulent marginal gingivitis. 

Etiology. — Mechanical or thermal irritants (such as rough 
edges of an overhanging filling), rough treatment in excava- 
ting or filling a cavity, overheating while drying a cavity, 
friction while excavating wth bur, or cutting down of fillings 
with sand-paper discs, careless use of ligatures (particularly 
when they are left upon the tooth for some time), the use of 
some strong caustics, or other drugs. 

Diagnosis. — Severe pain, usually of a throbbing character 
and other local signs of inflammation. The tooth is slightly 
loose, and protrudes somewhat from its socket. 

Treatment. — Removal of cause, local blood-letting, paint 
parts affected with iodine. 

Give the clinical appearance and the treatment of syph= 
ilitic interstitial gingivitis. 

Inflammation, attended with superficial ulceration of 
mucous membrane and general oozing of a grayish-white color. 

Treatment. — Iodides internally. Antiseptic mouth-washes 
locally. 

Describe the "direct method" of producing artificial 
respiration. 

In the direct method, the air is warmed and pumped into 
the lungs. The apparatus required is a pair of bellows, a 
face mask, and intubation tubes (in case the mask does not 
suffice). There should be a metal tube, with an opening in 
it, set in the rubber tubing, so that the operator can allow 



130 ORAL SURGERY. 

the escape of any excess of air blown by the bellows. If the 
mask is used a ligature should be passed through the tongue 
so that it may be readily held forward. If the air cannot 
enter the lung, intubation is to be performed, and there will 
be no difficulty. A respiratory rate of 16 to 20 a minute 
should be maintained. If there is no apparatus for warm- 
ing the air, the temperature of the room must be raised to 
at least 85° F. 

Give the etiology, pathology, symptoms, and treatment 
of hyperemia of the pulp. 

Etiology. — Irritation of bacteria, lactic acid, traumatism, 
exposure, denudation of root, and irritation from a filling. 

Pathology. — Practically that of a beginning inflammation. 
\\ hen cut into it bleeds rather freely. 

Symptoms. — Pain, increased by percussion, or by the appli- 
cation of either hot or cold substances. 

Treatment. — Local and general sedatives. Counter-irrita- 
tion. If pulp does not respond, local blood-letting. As a last 
resort the pulp may be destroyed. 

What precautionary measures should be observed in the 
ligation of arteries? 

Asepsis, avoid wounding important surrounding structures, 
make as small an opening as possible in the sheath, never tie 
near a collateral branch (or if forced to do so, tie branch 
also), and be sure that the ligature damages the inner and 
middle coats sufficiently to insure the obliteration of the 
vessel at that point. 

Give the treatment of septic wounds. 

Cleanse the wound as thoroughly as possible, syringe with 
hydrogen peroxide, and irrigate with bichloride (1-1000). 
If the septic condition of the wound is marked, solutions 
of chloride of zinc should be applied to all of its recesses. 
If the wound is large and irregular, rubber drainage tubes 
should be introduced into the most dependent positions. If 
the wound is small, gauze drainage may suffice. The best 



ORAL SURGERY. 131 

dressing is one of wet bichloride gauze. The constitutional 
treatment should be of a supporting character. 

Give the etiology, symptoms, and treatment of acute 
periostitis of the inferior maxilla. 

Etiology. — Traumatism, extension from a contiguous in- 
flammation (such as an alveolar abscess), the exanthemata 
(particularly measles and scarlet fever). It may also be 
caused by general conditions, such as rheumatism, gout, or 
pyemia. 

Symptoms. — The ordinary phenomena of acute inflamma- 
tion. The pain is of an intense aching character, worse at 
night, and increased by pressure. If the outer surface is 
involved, and the process go on to suppuration, a brawny 
swelling develops which softens in the center the overlying 
skin becoming reddened and edematous. When the abscess is 
opened, bare bone is felt, and the greater portion of the de- 
nuded structure dies. 

Treatment. — Rest, leeches, and fomentations locally, if seen 
early. A good purge should be given, and any underlying 
diathesis treated. If suppuration is threatened, a free in- 
cision should be made down to the bone. If necrosis has 
occurred, the parts must be dressed antiseptically, until the 
sequestrum is detached. If the sinus opens internally, anti- 
septic mouth-washes. 

Give the etiology and treatment of epistaxis. 

Etiology. — Traumatism, ulcers or tumors of the nasal sep- 
tum, rupture of varicose veins in mucous membrane of sep- 
tum, cerebral congestion, hemophilia, purpura, scurvy. 

Treatment.- — In the majority of cases there is a local cause. 
If the bleeding point is detected, it should be touched with 
a pointed galvano-cautery or with a swab saturated with a 
solution of chromic acid. Cold may be applied to the root 
of the nose and to the nape of the neck. If the bleeding- 
point cannot be located, the anterior nares should be packed 
with strips of aseptic gauze saturated with hydrogen per- 



132 ORAL SURGERY. 

oxide. If the hemorrhage still continues and the blood drips 
into the nasopharynx, the posterior nares must be plugged 
with the aid of Bellocq's sound or a rubber catheter. 

Describe the necessary preparation of patients for gen- 
eral anesthesia by ether or chloroform. State what rem- 
edies and instruments should be at hand. 

The patient should be examined as carefully as though he 
were an applicant for li^e insurance, and all organic diseases 
should be excluded. This includes physical examination of 
the lungs, heart, abdomen, etc., and chemical and micro- 
scopical examination of the urine. The night before the 
anesthesia the patient should receive a half-ounce of Epsom 
salts, and on the morning of the operation the lower bowel 
should be emptied by enema. Just before the anesthesia all 
loose bodies, false teeth, etc., should be removed from the 
mouth. No food should be taken for at least six hours be- 
fore the anesthesia. 

Instruments and remedies. — Sterile hypodermatic syringe 
and sterile solutions of atropine sulphate, strychnine sul- 
phate, nitro-glycerine. Brandy, ammonia, tongue forceps, 
and mouth gag. Tracheotomy instruments, a battery, and an 
apparatus for forced artificial respiration should always be 
within reach in a hospital. 

Give the treatment of wounds of the tongue. 

Arrest hemorrhage by exposure to the air, ice, hot water 
or ligation. If wound is small, sutures are not required. If 
large, deep-seated sutures should be introduced and the ends 
tied with more than ordinary care, since the motions of the 
tongue are apt to loosen the suture. An antiseptic mouth- 
wash should be prescribed. 

Define scarification. Give the method of this operation 
and state the results obtained, mention the necessary pre= 
cautions to be observed in scarification. 

By scarification is meant the operation of making numer- 
ous small superficial incisions. 



ORAL SURGERY. 133 

The incisions should be parallel, arranged in the form of a 
lozenge, and extend almost through the skin. 

The results obtained are bleeding and the relief of tension. 

The necessary precautions to be observed are the details 
of rigid asepsis. 

Mention three tumors of antrum. Give treatment. 

Osteoma, sarcoma, and carcinoma. 

Treatment. — The osteoma requires no treatment unless it 
presses upon important structures, or causes great deformity, 
when the offending portions of the tumor may be removed. 
Before such a partial operation is done, however, malignancy 
must be absolutely excluded. If a sarcoma or carcinoma can 
be thoroughly removed by an excision of the superior max- 
illa, this operation is indicated. If the malignant growth 
cannot be thoroughly removed, the toxins of erysipelas may 
be injected. 

Give the local treatment of hemorrhage. 

Exposure to air, cold, hot water, position (usually eleva- 
tion), direct pressure, styptics, cauterization, acupressure, 
forcipressure, torsion, and ligation. 

Give treatment of injuries of the mouth caused by car- 
bolic acid. 

Apply alcohol as quickly as possible to dissolve excess of 
carbolic acid. An antiseptic mouth-wash should then be used. 

Give the diagnosis and treatment of papillomata of the 
gums. 

Diagnosis. — It is an innocent epithelial tumor consisting 
of a fibrous stroma which contains blood-vessels, lymphatics, 
and an epithelial covering peculiar to the part from which 
it springs. The tumors • are generally multiple, wart-like 
growths, usually soft and seen upon the mucous membrane. 
They do not, as a rule, give pain, and are either smooth, 
rounded or of cauliflower shape. They are generally very 
vascular and bleed quite freely. Treatment, — Immediate and 



134 ORAL SURGERY. 

thorough removal since they show a most pronounced ten- 
dency to become malignant. 

Describe the technic of ligation of arteries. 

Thoroughly asepticize the part. Make an incision over the 
line of the artery. It is best to make this incision at an angle 
of five degrees to the line of the vessel. Divide the structures 
layer 03^ layer, avoiding important vessels and nerves. After 
dividing skin, superficial and deep fascia, the pulsations of 
the vessel should be sought for. When the sheath of the 
vessel is reached, it should be opened as far away from the 
vein as possible (example, open carotid sheath upon inner 
side). This opening in sheath should be just large enough 
to allow room for the aneurism needle. In passing the 
aneurism needle always go from the most difficult to the least 
difficult side, and never lift the artery up from its bed to a 
greater extent than is absolutely essential. Before tying the 
ligature be sure that it controls the circulation. In tying 
the ligature exert an equal amount of force upon both ends. 
After the vessel is ligated, the cutaneous wound is sutured 
and an aseptic dressing is applied. 

Give the differential diagnosis of ozaena and empyema 
of the antrum. 

In ozaena, the offensive discharge proceeds from both 
nostrils, and the nasal mucous membrane is atropic. The 
maxillary sinuses transmit light when the patient is in a dark 
room with an incandescent lamp in the mouth. There is an 
absence of any inflammatory symptoms in the tissues over- 
lying the antrum. 

In empyema of the antrum, the discharge proceeds from 
the nostrils of the affected side; the nasal mucous membrane 
upon the opposite side may be normal ; and the diseased 
maxillary sinus is more opaque to transmitted light than is 
the normal antrum. There are inflammatory symptoms in 
the tissues overlying the antrum. The cause of the empyema 
(such as an alveolar abscess) may be found. 



ORAL SURGERY. 135 

Give the diagnosis and clinical appearance of myeloid 
sarcoma. 

Myeloid sarcoma always grows from bone. It affects the 
long bones (particularly the upper end of humerus and tibia, 
lower end of femur). It most commonly affects individuals 
between 10 and 40 years of age, but it may occur in old age. 
The tumor is one of rather slow growth ; it may pulsate, fluc- 
tuate in certain portions of its extent, or give rise to egg- 
shell crackling. 

Give treatment of fracture of superior maxilla. State 
the complications that may arise. 

Correct any displacement; as a rule, all the treatment re- 
quired is to keep the patient quiet and apply cooling lotions 
to the part. The patient should be fed through a tube if the 
palatal process is involved. A dental plate should be applied 
to a broken alveolus. 

The complications that may arise are severe hemorrhage, 
suppuration (empyema of antrum), and necrosis. 

Give the clinical appearance, the symptoms and treat- 
ment of necrosis caused by an impacted wisdom tooth. 

The gums are usually discolored, slight bleeding is com- 
mon, pus exudes from numerous openings over affected area. 
Pain may or may not be present. If the condition is allowed 
to persist, the general health is impaired. 

Treatment. — Remove cause by extracting the malplaced 
tooth ; antiseptic mouth-washes should be freely employed. 
The necrosed portions of the alveolus should be freely re- 
moved. 

Give the diagnosis and treatment of fracture of the in- 
ferior maxilla. 

Crepitus may be obtained. The condyle is usually drawn 
forwards and inwards by the external pterygoid, while the 
body of the bone is freely movable antero-posteriorly, and is 
displaced towards the fractured side. 



136 ORAL SURGERY. 

Treatment. — Barton's bandage. Intermaxillary splints are 
deservedly unpopular. The most perfect results are undoubt- 
edly obtained by wiring. 

Differentiate neuritis and neuralgia. 

By neuritis is meant the inflammation of a nerve. 

By neuralgia is meant severe paroxysmal pain along the 
course of a nerve, and not associated with demonstrable 
structural changes in the nerve. 

The pain of neuritis is increased by pressure; the pain of 
neuralgia is frequently relieved by pressure. A differential 
diagnosis is sometimes impossible. 

Give the etiology and clinical features of epithelioma of 
the lip. 

Etiology. — It is commonly stated that this tumor is due to 
the irritation produced by smoking a short clay pipe, which 
is allowed to rest on one or the other side of the lip near 
the angle. It may also originate opposite a projecting rough 
or carious tooth. 

Pathology. — The affection may be a typical malignant 
ulcer, a wart-like growth subsequently becoming fungus and 
ulcerated, or a chronic infiltration leading to an irregular, 
nodular thickening. Sections of the growth show an abun- 
dance of "epithelial pearls." 

Clinical features. — Almost always affect lower lip. Rarely 
met with in women (1 in 20) . Occurs past middle life. Sub- 
mental and sub-maxillary glands not implicated for three or 
four months. Sore develops slowly. Sharp burning or lan- 
cinating pains. Odor often extremely offensive. 

Why should the hands be disinfected before a surgical 
operation. Describe the method used. 

Because the epidermis always contains pathogenic bacteria. 

Furbinger's method. — Hands and forearms are scrubbed 
continuously for five minutes with soap and aseptic nail- 
brush. The nails should be thoroughly cleaned and trimmed 
Khort. The hands are then plunged into absolute alcohol for 



ORAL SURGERY. 137 

at least one minute, and then are plunged while wet into a 
hot sublimate solution (1-1000) and thoroughly scrubbed 
with a nail-brush for at least one minute, particular atten- 
tion being directed to the nails. 

A better method is that of Kelly : The hands and fore- 
arms are cleansed as before with soap and water and the 
nails cleaned and pared. The hands and forearms are then 
immersed in a saturated solution of potassium permanganate 
until they are stained a deep mahogany red, or almost black. 
They are then immersed in a saturated solution of oxalic 
acid until they are completely decolorized. The oxalic acid 
is then washed off in sterile water. 

Describe the methods used in plastic surgery. 

Displacement. — Stretching or sliding of tissues. 1. Simple 
approximation after freshening the edges. 2. Sliding into 
position after transferring tension to adjoining localities. 

Interpolation. — Borrowing material from adjacent regions, 
from a limb or from another person. 1. Transferring a flap 
with a pedicle. 2. Transplanting without a pedicle. 

Retrenchment. — Removing redundant material and causing 
cicatricial contraction. 

Describe local anesthesia. State the precaution neces- 
sary in producing it. 

Local anesthesia is best effected by the use of cocaine, and 
may be employed with safety when the cocaine can be con- 
fined to a limited area. The part, say a finger, is asepticized 
and a stout ligature or fillet placed about its base. The 
cocaine is then injected between the layers of the skin and 
also in the vicinity of the digital nerves. The entire finger 
will be anesthetized within three or five minutes. 

Precautions — Asepsis. — Never risk the absorption of an 
amount of cocaine which exceeds the normal dose. At the 
conclusion of the operation, loosen the ligature and then 
tighten it again after five or ten seconds. Repeat at inter- 
vals so that the cocaine in the tissues will not all be absorbed 
at one time. 



138 ORAL SURGERY. 

Give the clinical appearance of squamous lesions of 
syphilis in the mouth. 

The epithelium is whitish and opaline, resembling a sur- 
face that has been touched by nitrate of silver. If eroded, 
the surface is red and smooth after the superficial epithelium 
has desquamated. The patch is always circular or regularly 
oval and the derma is thickened upon its surface. 

Give a differential diagnosis of an abscess, a cyst and a 
fatty tumor. 

An abscess is characterized by redness, heat, pain, swell- 
ing, fever, fluctuation, pointing, and the hypodermatic needle 
reveals pus. 

A cyst is characterized by an absence of inflammatory 
symptoms, unless it is inflamed. Fluctuation is present and 
the hypodermatic needle reveals a non-purulent fluid. A 
superficial cyst can be better outlined than is the case with 
an abscess. 

A fatty tumor is inelastic and doughy to the touch. It is 
adherent to the skin and, when it is moved, causes a dimpling 
of the overlying integument. There is an abscess of inflam- 
matory symptoms. 

State a method of sterilizing sponges. 

The sponges should be placed in a muslin bag and well 
pounded to remove all particles of sand and other foreign 
materials. They are then rinsed out in water several times. 
A very good way is to place them in a basil or pail, and 
allow the water to run in upon them from a tap for sev- 
eral hours. They are next soaked in a saturated solution of 
permanganate of potassium, are afterwards decolorized in a 
solution of oxalic or of sulphuric acid, and are then left for 
twenty-four hours in an aqueous solution of hydrochloric 
acid, made strong enough to taste slightly sour. After this, 
they are again soaked in water until the washings are clear. 
They are next placed in a bichloride solution (1-500) for 
twelve hours, and finally are rinsed in warm water and pre- 



ORAL SURGERY. 139 

served in covered glass jars containing a three per cent, 
aqueous solution of carbolic acid, the solution being changed 
every week. 

What class of patients should not be anesthetized by 
(a) nitrous oxide, (b) chloroform, (c) ether? 

(a) Those with diseased blood-vessels. Those in whom 
complete muscular relaxation is desired. 
(6) Those with myocardial disease. 
(c) Those with bronchitis or Bright's disease. 

Give reason for removing a blood clot from the surface 
of a wound. 

The chief reason for removing a clot is that it is capable 
of forming a most excellent culture medium for the growth 
of bacteria. Its presence consequently favors the develop- 
ment of sepsis. If the clot is not removed by the surgeon, 
it will be removed by nature, since it is nothing more nor 
less than a foreign body. 

Give the etiology and treatment of erosion. 

Etiology. — Acids attacking the necks of the teeth. The 
acid may proceed from the buccal glands or be regurgitated 
from the stomach. 

Treatment. — Applications of milk of magnesia, chalk, or 
some such alkaline substance. Correct any digestive defect 
and destroy the glands by the cautery, if they can be defi- 
nitely located. The eroded places should be filled. 

Give the method of operation for exposing the inferior 
dental nerve. 

Incision, two inches in length, along the lower border of the 
jaw, beginning slightly behind the angle and well under the 
border. The upper edge of the wound is displaced upward 
over the ramus, the masseter muscle is separated from the 
bone with a periosteal elevator, and a %-inch trephine ap- 
plied one inch and a quarter above the angle. This exposes 
the nerve at its entrance into the inferior dental foramen. 



140 ORAL SURGERY. 

The nerve may be brought to the surface by a small hook, or 
the incision may be prolonged above and parallel to the edge 
of the jaw and the canal for the nerve laid open all the way 
to the mental foramen. 

What dangers may result from punctured wounds? 
Give treatment. 

The greatest danger is sepsis. Another is tetanus. A 
lesser danger is injury of deep structures. 

Treatment. — Secure efficient drainage and pack the wound 
so as to make it heal up from the bottom. Infection with 
tetanus should be guarded against by opening up all parts of 
the wound so that the oxygen of the air may gain free access. 

Describe Barton's bandage. 

The roller should be two inches in width and six yards in 
length. The initial extremity of the roller is placed on the 
head just behind the mastoid process. The bandage is then 
carried under the occipital protuberance, obliquely upward, 
under and in front of the parietal eminence, across the vortex 
of the skull, then downward over the zygomatic arch, under 
the chin, thence upward over the opposite zygomatic arch 
and over the top of the head, crossing the first turn as nearly 
as possible in the median line, and thence carrying the turns 
of the roller under the parietal eminence to the point of 
commencement. The bandage is then passed obliquely around 
under the occipital protuberance and forward under the ear 
to the front of the chin, thence back to the point from which 
the roller started. These figure-eight turns over the head 
and the circular turns from the occiput to the chin should 
be repeated, each turn exactly overlapping the preceding one 
until the bandage is exhausted. 

Differentiate an ulcer and a fistula. 

An ulcer is a solution of continuity of the skin or mucous 
membrane due to molecular death of the part. 

A fistula is a suppurating tract connecting a cutaneous or 
mucous surface with a normal cavity of the body, or connect- 



ORAL SURGERY. 141 

ing two normal cavities. Strictly speaking a fistula always 
has two openings. 

Give the diagnosis of ulcerating gumma of the oral 
cavity. 

Preceding history of syphilitic infection and the presence 
of an inflammatory swelling, the surface of which is ulcer- 
ated. The ulcer is deeply excavated, the edge is undermined, 
the surrounding tissues are hyperemic, and there is a tough 
or soft tenacious slough adherent to its base. There is no 
glandular involvement, as a rule ; the sore will heal under 
specific treatment and leave a depressed scar or a perforation. 

Give the differential diagnosis between malignant and 
non=malignant tumors of the upper jaw. 

Malignant tumors grow rapidly, give metastasis, are pain- 
ful, recur after removal, may ulcerate, and finally cause death. 

Non-malignant tumors grow slowly, do not give metastasis, 
are not painful (except by pressure), do not recur after 
removal, rarely ulcerate, and do not cause death (except 
mechanically). The malignant tumors of the upper jaw are 
of more frequent occurrence than are the benign. 

Give the direction for diagnosis of mercurial stomatitis. 

The diagnosis is made by observing the following points: 
The individual may work in mercury or have been taking the 
drug internally. There will be tenderness of the gums, mani- 
fested by bringing the teeth forcibly together, redness of the 
gums near the insertion of the teeth, a metallic taste, profuse 
salivation, fetor of breath, the tongue may be reddened, swol- 
len, and ulcerated, and protrude from the mouth. In severe 
cases, ulceration of the mucous membrane, loss of teeth, and 
necrosis of the jaw may result. 

Describe a four=tai!ed bandage. 

This bandage is prepared by taking a portion of a roller 
bandage, three inches wide and one yard in length, and split- 
ting each extremity up to within two inches of the center. 



142 ORAL SURGERY. 

The undivided portion of the bandage is placed upon the 
point of the chin. The two lower tails are then drawn up 
and tied over the vortex while the two upper tails are secured 
behind the occiput and then, to prevent slipping, these ends 
are knotted to the ends of the former. 

What precaution should be taken in extracting molars 
and bicuspids of the inferior maxilla? 

The usual antiseptic precautions, such as sterilization of 
instruments, and cleansing of parts by germicidal solutions. 
The selection of a proper forceps, the history as to previous 
extraction, whether difficult or a tendency to hemophilia, and 
above all, keep in mind the fact that fracture may occur 
either in the body or in the alveolar process if violence is 
used. The jaw may also be dislocated. The proper motion 
for loosening root attachments should be applied and some 
guard placed over the upper teeth to prevent breaking them. 
Be prepared to treat sbock and hemorrhage. 

Give the pathology and treatment of epithelioma. 

Pathology. — Squamous epitheliomata are nodula or wart- 
like elevations of the skin or mucous membranes tending to 
superficial ulceration. The microscope reveals branching 
columns of epithelial cells extending from the papillae of the 
skin into the deeper structures. "Cell-nests" are freqiient. 
Involvement of the lymphatic glands is less marked than in 
the remaining forms of carcinoma. 

Cvlindric epithelioma. — Found in gastro-intestinal tract 
and in uterus. They are composed of acinus^like tubular 
structures, frequently composed of a number of layers of 
epithelium, the outer layer often being distinctly columnar. 
Later on, the acini become filled with epithelial cells of vari- 
ous shapes and the cvlindric character is lost. They more 
nearly resemble the glandular cancers in their general char- 
acteristics than does the squamous variety. 

Treatment. — Thorough excision of the involved tissue wher- 
ever found. If a squamous epithelioma is local beyond doubt, 



ORAL SURGERY. 143 

and there be no lymphatic involvement (as in rodent ulcer), 
the growth may be destroyed by Michel's or Bougard's paste. 

Describe palliative treatment of malignant tumors of 
the mouth. 

The palliative treatment of malignant tumors of the mouth 
consists in keeping the buccal cavity as aseptic as possible 
by means of antiseptic mouth-washes. Local anesthetics 
(cocaine, menthol) are employed. Morphine is administered, 
and in some cases it has been advised to divide the lingual 
nerve. If the case is one of sarcoma, Coley's fluid may be 
tried. The X-ray is a recent addition. 

Give the treatment of a case of non=union in fracture 
of the inferior maxilla. 

Make incision along lower border of the body of the jaw, 
expose fragments, remove any intervening tissue, freshen 
edges, and wire together. In some cases it may suffice to rub 
the ends of the fragments together and then apply a Ham- 
mond splint. 

Give treatment of a lacerated wound. 

If the wound can be thoroughly cleansed and the edges 
have not been markedly contused, such a wound should be 
sutured and a wet bichloride dressing applied. If the wound 
cannot be thoroughly cleansed or if the edges are contused, 
clean the wound as thoroughly as possible, irrigate with a 
bichloride solution (1-2000), and apply warm antiseptic 
fomentations until all sloughs have separated. The wound 
should then be treated like any granulating surface. 

What is arthritis? Give treatment. 

By anthritis is meant an inflammation of a joint which in- 
volves all the structures of which it is composed. 

Treatment of Acute Anthritis. — In early stage, elevate the 
limb, immobilize absolutely, and put in such position that, if 
ankylosis occurs, the part will be of some use to the patient. 
Fomentations or an ice-bag may also be applied. As soon 



144 ORAL SURGERY. 

as symptoms of approaching suppuration appear, open joint 
freely in one (or better two) places, and wash out with some 
sterile or antiseptic solution (normal saline solution or sub- 
limate 1-8000). Maintain fixation, continue irrigation until 
all symptoms of inflammation have disappeared, and look 
after the general health. If ankylosis occurs in a faulty 
position, resection of the joint may be required. 

How would you arrest hemorrhage from the tongue? 

Hemorrhage from the tongue may be arrested by exposure 
to the air, by ice, hot water, ligation, suture, and the cautery. 

Give etiology and treatment of false ankylosis. 

Etiology. — Inflammation outside of the joint, disuse. 

Treatment. — Where inflammation has been cured, massage 
and passive motion, the alternate hot and cold douche, and 
graduated exercise. If due to disuse, exercise, massage and 
galvanism. 

Define neuritis. Give cause and treatment. 

By neuritis is meant the inflammation of a nerve. 

Causes. — Inflammation, exposure to cold, some abnormal 
condition of the blood induced by rheumatism, chronic al- 
cholism, diabetes, etc. 

Treatment. — Keep part at rest. Apply blisters along the 
course of the nerve. The administration of small doses of 
bichloride of mercury is sometimes of benefit. Treat any 
local cause or constitutional dyscrasia. It may be necessary 
to control pain by hypodermatic injections of morphine. 

When should a sequestrum be removed? 

A sequestrum should be removed as soon as it has separ- 
ated. If the sequestrum is central (as in inferior maxilla), 
it should be left until the involucrum becomes sufficiently 
strong, the case meanwhile receiving appropriate antiseptic 
treatment. In such an instance, etc., the sequestrum acts as 
a splint. 



ORAL SURGERY. 145 

Define asphyxia. Give treatment. 

Asphyxia is suffocation. The suspension of vital pheno- 
mena which results when the lungs are deprived of oxygen. 

Treatment. — Remove any local cause. If impossible to re- 
move cause (in the larynx, for example), quickly perform 
tracheotomy below obstruction. After obstruction is removed 
or circumvented, artificial respiration is always indicated. 
If no local obstruction, artificial respiration from beginning; 
strychnine, atropine, or probably cocaine should be given 
by an assistant while the operator is performing artificial 
respiration. 

How should chloroform be administered? Ether? What 
accidents may occur? Give treatment. 

Chloroform should be administered in free admixture with 
air (chloroform vapor 5%, air 95%). 

Ether should also be administered by the open method 
(ether vapor 95%, air 5%). 

Accidents. — Death from cardiac or respiratory paralysis, 
mechanical asphyxia, congestion of brain, or by the entrance 
of vomited material into the larynx. 

Treatment. — Failure of respiration is treated by with- 
drawal of anesthetic, clearing out throat and pulling forward 
of tongue, the performance of artificial respiration, the ex- 
hibition of pungent aromatics (ammonia), the hypodermatic 
injection of strychnine, atropine, or cocaine, the alternate 
douche of hot and cold water, and the use of the "electric 
brush." 

Failure of circulation. — Withdraw the anesthetic, invert the 
patient, give hypodermatic injections of whisky and strych- 
nine, and perform artificial respiration, clearing out the 
mouth and holding the tongue forward. 

Describe the operation for removing calculi from the 
salivary duct. 

The calculus is located by means of a probe and the pal- 
pating finger; the duct is incised and the calculus removed. 
10 



146 ORAL SURGERY. 

If the calculus is situated in the substance of the submaxil- 
lary gland, total removal of the gland may be necessary. In 
some cases the calculus may be seen projecting from the main 
duct of a gland, in which case it may be removed without 
incision. 

How are the wounds of arteries classified? 

Incised, lacerated, contused, punctured, poisoned, and gun- 
shot. 

They are sometimes divided into those in which the artery 
is completely divided and into those in which the artery is 
only partially divided. 

What is the difference between a traumatic and a con- 
genital dislocation? 

A traumatic dislocation is one produced by the application 
of external violence and muscular force, acting alone or in 
combination. 

A congenital dislocation is a malformation of a joint which 
exists at birth. 

Describe Gibson's bandage. 

The roller should be two inches in width and six yards in 
length. The initial extremity of the roller should be placed 
upon the vertex of the skull in a line with the anterior por- 
tion of the ear; the bandage is then carried downward in 
front of the ear to the chin, passed under the chin, and car- 
ried upward on the same line until it reaches the point of 
starting. The same turns are repeated until three complete 
turns have been made. The bandage is then continued until 
it reaches a point just above the ear, where it is reversed, 
carried backward around the occiput, and continued around 
the head and forehead until it reaches its point of origin; 
these circular turns are continued until three turns have 
been made. When the bandage reaches the occiput, having 
completed the third turn, it is allowed to drop down to the 
base of the skull, and it is then carried forward below the 
ear and across the chin, being brought back upon the opposite 



ORAL SURGERY. 147 

side of the head and neck to the point of origin; these turns 
are repeated until three complete turns have been made, and 
upon the completion of the third turn, the bandage is re- 
versed and carried forward over the occiput and vertex to 
the forehead, and its extremity is here secured with a pin. 
Pins should also be applied at the points where the turns of 
the bandage cross each other. 

Give the etiology, diagnosis, and treatment of tetanus. 

Etiology. — The infection of a wound with the bacillus 
tetani. It is more common in hot climates, in dark-skinned 
races, and in those who are employed about stables. Hygienic 
errors favor development, particularly the overcrowding of 
sick and wounded in a limited space. 

Diagnosis. — Trismus, opisthotonos, emprosthotonos, or pleu- 
rosthotonos. The spasms are tonic in character with clonic 
exacerbations. Constipation and retention of urine are pres- 
ent. The mind is clear, there is a hypersecretion of sweat, 
and little or no fever. It may be possible to discover the 
source of infection. 

Treatment. — Preventive treatment consists of applying the 
principles of antisepsis to every wound encountered. 

Local treatment.— Antiseptic treatment of wound. 

Symptomatic treatment. — Chloroform during the exacerba- 
tions of the spasm and chloral between the exacerbations. 
The introduction of food into the stomach by stomach-tube, 
and the evacuation of the rectum and bladder at regular in- 
tervals. Calabar bean has been highly recommended. 

Specific treatment. — The administration of the antitoxin, 
which is best done by trephining and introducing it beneath 
the dura mater. The results obtained in man are anything 
but promising. 

What is pyorrhea alveolaris? Give the etiology and 
treatment. 

Pyorrhea alveolaris is an inflammatory condition of the 
margins of the gums, accompanied by a muco-purulent dis- 



148 ORAL SURGERY. 

charge, which arises from pockets or pouches extending for a 
greater or less distance along the roots of the teeth. 

Etiology. — Gout, uric acid, diabetes, certain conditions of 
diet, and irregularities of the teeth might be mentioned as 
predisposing factors. It is always preceded by an excessive 
deposit of tartar, beneath which bacterial infection occurs. 

Treatment. — Removal of tartar and application of astrin- 
gents and antiseptics, preferably peroxide of hydrogen. 
These applications must be made to all parts of the pouches 
or pockets. Sulphuric acid has been recently recommended. 
The treatment is prolonged and tedious. In many cases the 
teeth have been sacrificed, t 

Define a cyst. Mention three divisions of cysts and 
give the etiology and treatment of one division. 

By a cyst is meant a more or less rounded cavity with a 
distinct lining membrane, distended with some fluid or semi- 
solid material. 

1. Cysts formed by the distension of pre-existing spaces. 

2. Cysts of embryonic origin. 

3. Cysts of new formation. 

Etiology. — Dermoids may be due to the persistence of epi- 
thelial cells, in the deeper tissues, in situations where fleshy 
segments coalesce during fetal life. They may also be due to 
the persistence of certain tubular canals (thyro-glossal duct, 
post-anal gut) . 

Cysts of embryonic origin (dermoids) are to be removed 
by careful dissection. 

What are aseptic wounds? Describe an aseptic wound. 

Aseptic wounds include all which are preserved from con- 
tamination by poisonous bacterial products, whether such 
poison come in contact with the wound directly or be gener- 
ated in it by the action of germs that gain access to it. 

In an aseptic wound the process of healing is undisturbed, 
union occurs by first intention, there is no suppuration and 
no visible sign of inflammation. 



ORAL SURGERY. 149 

How should a penetrating wound of the temporo=maxil- 
lary articulation be treated? 

If the wound is small and there is reason to believe that 
it was made by an aseptic instrument, the skin should be 
thoroughly cleansed and an antiseptic dressing applied. A 
careful watch is then kept upon the condition of the joint 
and the temperature of the patient ; as soon as signs of acute 
arthritis manifest themselves, free incisions are to be made 
into the joint, so as to relieve tension and allow of irrigation. 

If the wound was inflicted by a dirty instrument, the 
wound should be enlarged, if necessary, so that its depths may 
be carefully examined and thoroughly cleansed. The cavity 
should be irrigated and drainage inserted. If acute arthritis 
supervenes, it must be treated in the usual way. 

Where are salivary calculi most frequently found? 
Give treatment. 

Salivary calculi are most frequently found upon the necks 
of the teeth opposite to the salivary ducts and in the duct of 
Wharton. 

Treatment. — Removal and the regular use of Philipp 's milk 
of magnesia. If protruding from orifice of the duct, they 
may simply be extracted. If within the duct, they should 
be cut down upon and removed. 

How should a salivary fistula be treated? 

This affection practically always occurs in relation to Sten- 
son's duct. If the buccal portion is involved, the duct may 
be slit up from within the mouth. If the masseteric portion 
is wounded, a fine probe should be passed into the duct (from 
the mouth) as far as the fistulous opening, and then brought 
out at this orifice. A double thread of silk is now tied to 
the end of the probe and drawn through the thickness of the 
cheek, along the buccal portion of the duct, and out of the 
external wound. A fine drainage tube is then carried along 
the same tract, and left to project both externally and inter- 
nally. A silk thread is attached to each end of the tube 



150 ORAL SURGERY. 

and knotted around the angle of the mouth. In this manner 
a passage is re-established into the mouth, and as soon as it 
becomes easier for the saliva to travel along this than through 
the external wound, the fistula will close. The outer half of 
the tube may be removed in a few days, and only a thread 
allowed to remain in the external wound, which gradually 
contracts so that more and more of the saliva finds its way 
to the mouth. The silk thread and tube are finally removed, 
and, if the canal remains patent, the external wound soon 
heals. If the buccal portion of duct is obliterated so that 
the probe cannot be introduced, the thread and tube may be 
passed through all of the tissues of the cheek by means of a 
trocar and canula. The subsequent steps are similar to those 
of the previous method. 

How should hemorrhage from the gums be treated? 

By means of hot water, cold, compression, peroxide of hy- 
drogen, styptics, suprarenal extract, or the actual cautery. 
If due to scurvy, appropriate antiscorbutic treatment; if due 
to hemophilia, calcium chloride gr. xxx t. i. d. and apply 
fibrin ferment, suprarenal extract, or cocaine, locally. 

Define necrosis. Give its diagnosis and treatment. 

By necrosis is meant the death of bone en masse. 

The diagnosis is made by the presence of a sinus, the his- 
tory of a preceding inflammation, and the results obtained 
by probing. Dead bone feels rough and hard; the probing 
is not painful nor is it followed by bleeding. 

Treatment. — Early in necrosis, endeavor to moderate in- 
flammation upon which the affection depends and open any 
abscesses that may form. During the time occupied by the 
loosening of the dead bone, no operative treatment should 
be instituted, as a rule, but attention should be given to the 
general health. As soon as the necrosed portion has become 
detached, it should be removed. 



ORAL SURGEEY. 151 

What is a dislocation? Name the varieties, and give 
the causes. 

A dislocation is a displacement of one or more bones of a' 
joint from its natural position. It is also the displacement 
of any organ from its natural position. 

Traumatic. — Due to violence or muscular action. 

Pathologic. — Due to disease. 

Congenital. — Due to an error of development as a result of 
which a normal location of the bony constituents has never 
been present. (The term congenital "dislocation" is really 
a misnomer — it is a congenital malformation.) 

What is an incised wound? Give the prognosis and 
treatment. 

An incised wound is one made by any sharp-cutting in- 
strument. 

Prognosis. — Nearly always favorable, but depends upon the 
region involved and asepsis of the wound. 

Treatment. — Arrest hemorrhage. Render the wound as 
aseptic as possible. Unite the edges of the wound by means 
of sutures and apply a septic dressing. 

Give diagnosis and treatment of caries. 

The symptoms of caries are those of osteitis complicated 
by an abscess leading to the softened bone. When caries is 
primary, it particularly involves the cancellous tissue (ends 
of long bones, flat bones) . The pus from carious bone con- 
tains an excess of phosphate of lime. 

Treatment. — If syphilitic, give potassium iodide; if tuber- 
cular, cod-liver oil with iodide of iron. Secure best hygienic 
surroundings. In early stages while the disease is advancing, 
keep the parts clean and free from irritation. When acute 
symptoms have subsided, an attempt may be made to remove 
the diseased bone by applications of iodine or of the mineral 
acids. If the carious bone can be reached from the surface, 
it may be removed with a gouge or with a burr-head drill. If 



152 ORAL SURGERY. 

the disease is extensive, excision may be required. In some 
eases amputation is necessary to prevent fatal exhaustion. 

How may general infection be caused by oral opera- 
tions? 

The wound in the buccal cavity may become infected by 
any of the micro-organisms found within the mouth. From 
this local source, the bacteria, their products, or both, may 
pass into the general circulation. 

Give the symptoms and treatment of acute suppurative 
periostitis. 

If the bone is superficial, there will be all of the symptoms 
and signs of inflammation. If the bone is deep, redness, 
swelling, and heat may not be observed over the inflamed 
area, on account of the density of the periosteum. The pain 
is of a most intense, aching character, worse at night, and 
greatly increased by pressure or by a dependent position of 
the part. If swelling is present, it is brawny in character 
and subsequently becomes red, edematous and softened in the 
center. If the abscess has opened spontaneously or has been 
incised, bare bone is exposed, the greater portion of which 
usually dies. This dead bone is either absorbed (if very small 
in amount) or cast off as a sequestrum. 

Treatment. — A free aseptic incision down to the bone at the 
earliest possible moment. Antiseptic dressing. If necrosis 
has occurred, it must receive appropriate treatment. Sup- 
porting or antidiabetic treatment constitutionally. 

Give the differential diagnosis between syphilitic and 
aphthous ulceration. 

Syphilitic ulcers occur in the shape of cracks or fissures 
upon the sides or tip of the tongue, or upon the cheeks and 
lips. They are common in the secondary period of the disease. 
Papular eruptions of the skin and mucous patches may also 
be observed. These ulcers respond to anti-syphilitic treatment. 

Aphthae commence as small blisters, which run a rapid 
course and are accompanied by slight salivation. The ulcers 



ORAL SURGERY. 153 

are superficial, sharply outlined, multiple, and are situated 
not only upon the tongue, but particularly upon the cheeks 
and lips. 

Give the etiology and symptoms of the congenital mal= 
formation known as cleft palate. 

Etiology. — Failure of the palatal processes to unite. 

Symptoms. — Inspection reveals a cleft in the median line. 
If the palatal process of one side has united with the ethmo- 
vomerine septum, a cleft slightly to one side (usually to the 
left) of the median line is observed. Since the union of the 
palatal processes takes place from before backward, it is rare 
to have a cleft of the anterior portion of the palate without 
the posterior portion being also involved. As a rule, there is 
considerable impairment of nutrition, from interference with 
deglutition. The exposure of the nasal mucous membrane 
leads to the formation of scabs which undergo putrefactive 
changes, producing a condition somewhat resembling ozaena. 
When the child learns to talk, articulation is frequently so 
indistinct that it is difficult to understand, and the voice has 
a peculiar and characteristic intonation. The so-called ex- 
plosives (whether dentals, labials, or gutturals) which re- 
quire a certain amount of air-pressure within the mouth for 
their proper pronunciation, are difficult to produce. This is 
particularly to be observed in the letters b, d, p, t, g and f. 

Give the diagnosis and treatment of trismus caused by 
impacted third molar. 

Diagnosis. — There is a partial or complete inability to open 
the jaws. Inspection reveals the impaction of the third 
molar. Necrosis may be present. 

Treatment. — Relief of the impaction, either by extraction 
of the offending tooth or of the second molar. If necrosis is 
present, it must be treated upon general principles. 

Mention the most reliable agent for the destruction of 
micro=organisms. How should it be used? 

Heat. — It may be used in the form of dry heat or moist 



154 ORAL SURGERY. 

heat (steam, under pressure if necessary, hot water). It 
should penetrate to the center of the material to be sterilized. 

What diseases of the tongue may be caused by diseased 
teeth? 

Traumatic ulceration, glossitis, abscess, and epithelioma. 

Describe the preparation of the oral cavity for an 
aseptic operation. 

Asepsis, as applied to the oral cavity, is but a relative term. 
All cavities in the teeth should be cleansed, disinfected and 
filled. The interstices between the teeth must be carefully 
cleansed and the mouth repeatedly washed out by a boric acid 
solution as hot as can be borne. The nasal cavity should also 
be rendered as aseptic as possible, and the patient should 
gargle repeatedly with hot boric acid solutions. 

Define a multilocular cyst. 

A multilocular cyst is one which is composed of a number 
of loculi or chambers. 

Describe treatment and appliance for acquired cleft 
palate. 

Acquired perforations of the palate are usually due to 
syphilis, but lupus and traumatism are also occasional causes. 
Treatment should first be directed to the underlying cause. 
When inflammatory symptoms have subsided and nature has 
done all she can to repair the defect, the local treatment is 
indicated. If the perforation is small, an attempt may be 
made to close it by freshening the edges of the perforation, 
dissecting up muco-periosteal flaps and suturing them to- 
gether. This will rarely be practicable, however, and in the 
great majority of cases an obturator or an artificial velum 
must be introduced. 

An obturator is a plate which is so adjusted as to close the 
perforation. It should never be made in the form of a plug, 
since the opening may be enlarged by the constant pressure 
and irritation. It is made of thin vulcanite or gold, and is 



ORAL SURGERY. 155 

fixed to the teeth and held in position by suction. Intra- 
nasal projection will sometimes improve the quality of the 
articulation by diminishing the size of the nasal cavity. 

An artificial velum is a plate obturator, to the posterior por- 
tion of which a hinged segment is attached, to take the place 
of the normal velum. This hinged segment may rest upon 
the nasal side of the soft palate. A thin rubber bag, filled 
with air and sewn to the posterior portion of the obturator, 
is sometimes used in place of the hinged segment. Artificial 
vela are by no means so satisfactory, as a rule, as are the 
plate obturators. 

Define odontalgia. Give the etiology and treatment of 
odontalgia. 

Toothache. 

It may be caused by many different pathologic conditions 
of the tooth or surrounding tissues, such as congestion of the 
pulp, exostosis of the roots, pulp nodules, mechanical or 
chemical irritation, reflected pains from irritation of areas 
supplied by other branches of the fifth nerve (impacted body 
in external auditory meatus, etc.), infection, mal-occlusion, 
exposure of dentine and denudation of roots. 

Treatment. — Removal of the cause. In the majority of 
cases the pulp of the tooth must be removed. Tincture of 
iodine to the gums and chloroform or oil of cloves to cavities 
in teeth, might be mentioned as temporary measures. 

Describe (a) Sylvester's method of producing artificial 
respiration; (b) Laborde's method of producing artificial 
respiration. 

(a) Sylvester's method. — The patient is placed upon his 
back with a folded coat or a pillow beneath the interscapular 
region, the throat is cleared of mucus, the tongue held well 
forward, and all constricting clothing removed from throat 
and abdomen. The operator kneels or stands behind the 
patient. The forearms are grasped near the fully-flexed 
elbows and the lower portion of the thorax is compressed for 



156 ORAL SURGERY. 

a few seconds by forcing the patient's elbows against the 
thoracic wall. The arms are then moved outward and up- 
wards until the hands cross over the head. This secures ele- 
vation of the costal walls and simulates inspiration. The 
arms are kept in this position for a few seconds and then 
brought downward to the first position, pressure being made 
upon the costal walls with the elbows of the patient. This 
stimulates expiration. These movements are to be repeated 
from twelve to fifteen times a minute. 

(6) Laborde's method. — After clearing the throat of 
mucus, rhythmic traction is made upon the tongue. 

Describe the effect of arsenic upon the pulp of a tooth. 

The pulp becomes devitalized and there is an absence of the 
previously existing sensibility, as may be demonstrated by 
the use of any exploring instrument. 

State the pathologic changes in chronic inflammation. 

Dilatation of blood-vessels, slowing of current, exudation 
of fluid, transmigration of leucocytes and multiplication of 
the pre-existing connective tissue cells of the part. The only 
difference between acute and chronic inflammation is one of 
degree. In chronic inflammation the productive changes are 
much more marked than the exudative or the degenerative 
ones. 

Describe the healing of wounds, irrespective of the ana- 
tomic structure of the tissue involved. 

The healing of an aseptic wound will be described. There 
is a certain amount of exudation, resulting in the formation 
of fibrin, which temporarily binds the lips of the wound to- 
gether. This network of fibrin serves as a framework for the 
leucocytes and multiplied connective tissue cells. The exu- 
date becomes vascularized, and is then known as granulation 
tissue. The leucocytes have nothing to do with the building 
up of tissue. They destroy the fibrin network and then either 
return to the circulation or are fed upon by the connective 
tissue cells or fibroblasts. The fibroblasts soon become spindle- 



ORAL SURGERY. 157 

shaped, and their ends become split up into primitive fibrillae. 
This conversion of the round fibroblasts into the connective 
tissue fibre results in the contraction of the cicatrix, which 
binds the lips of the wound tightly together. 

Define contusion, luxation and fracture. 

A contusion is a subcutaneous laceration of the tissues. 

A luxation is a displacement, as regards their relative posi- 
tion, of the bones which enter into the formation of a joint. 

A fracture is a solution of continuity of bone, produced by 
violence. 

Name two forms of tumors which may involve the 
tissues of the face or jaws. State whether benign or 
malignant, and briefly outline surgical treatment. 

Epithelioma, sarcoma. 

Both of these tumors are malignant. 

The treatment consists of the thorough removal of all of 
the affected tissues. If a complete operation cannot be per- 
formed, the treatment is simply palliative. 

Name three congenital deformities of the oral tissues 
which affect the speech. Briefly outline the surgical 
treatment of each. 

Macroglossia, hare-lip, and cleft palate. 

Macroglossia is best treated by removing a V-shaped piece 
of the tongue, with the apex directed backward, and uniting 
the resulting wound by sutures. 

Hare-lip is treated by paring the edges of the cleft and 
bringing them together by sutures. The depth of the lip 
should be increased to allow for subsequent contraction. 

Cleft palate is treated by paring the margins of the cleft, 
together with its anterior angle, elevating the two lateral 
flaps of mucoperiosteum and uniting them in the median line 
by sutures. Lateral incisions are made if it is necessary to 
relieve tension. 

Give the causes of antral empyema. 

The extension of inflammation from carious teeth, direct 



158 ORAL SUEGEBY. 

violence applied over the cavity, an injury to the alveolar 
process which opens the antrum, and the extension of a sup- 
purative process from the nasal cavity. 

Differentiate between fracture and dislocation of the 
mandibular condyle. 

In fracture of the neck of the condyle, the condyloid frag- 
ment is drawn forward and inward by the external pterygoid 
muscle and the body of the bone is displaced toward the oppo- 
site side, somewhat simulating a dislocation. The mouth is 
closed, however, and any attempt to open it produces pain and 
generally crepitus. The deformity recurs almost immediately 
after reduction unless the fragments are held in apposition. 

In dislocation of the mandibular condyle (unilateral dis- 
location of the jaw) the mouth is open and cannot be closed. 
The chin is directed toward the sound side. Upon external 
palpation the condyle can be felt in front of its normal posi- 
tion, which is the site of a vacuity; upon internal palpation 
the coronoid process may be felt in an advanced position. 
Crepitus is absent and the deformity does not recur after 
reduction as long as the mouth is kept closed. 

a. Describe tic doloreux. b. Why is it of special inter- 
est to the dentist? c. What surgical operations are prac- 
ticed for its relief? 

a. Tic doloreux or trifacial neuralgia is characterized by 
severe paroxysmal pain in the region supplied by one or 
more of the divisions of the trifacial nerve and is not asso- 
ciated with structural changes in the nerve. 

b. Tic doloreux is of special interest to the dentist because 
it may simulate affections of the teeth, of the alveolar process, 
or of the maxillary antrum. 

c. The surgical operations practiced for its relief are neu- 
rectomy of the affected branch of the fifth nerve, excision 
of the nerve and plugging the particular canal, removal of 
Meckel's ganglion, and removal of the Gasserian ganglion. 



ORAL SURGERY. 159 

Give the diagnosis of ranula. 

A ranula is a cystic swelling in the floor of the mouth gen- 
erally to one side of the median line. It is translucent and 
bluish in appearance and is covered with thin healthy mucous 
membrane. The fluctuating mass may push up the anterior 
portion of the tongue and interfere with deglutition and 
articulation. Inflammatory symptoms are absent. Puncture 
reveals a glairy viscid fluid somewhat resembling saliva. 

A dermoid cyst in this region usually involves the tongue 
to a greater or less degree, is more deeply placed than a 
ranula, and is more apt to project and give fluctuation in 
the submaxillary region. 

Differentiate between dislocation and double fracture 
of the lower jaw. 

In bilateral dislocation, the mouth is wide open and cannot 
be closed. Upon both sides there is a vacuity in front of the 
tragus and the condyle may be palpated in an advanced posi- 
tion ; palpation from within the mouth reveals an anterior 
displacement of the coronoid processes. The chin is carried 
forward and downward so that face seems to be elongated. 

Double fracture is characterized by loosening and irreg- 
ularity of the teeth, preternatural mobility, crepitus, and 
dribbling of bloody saliva. The central fragment is dis- 
placed downwards by the suprahyoid muscles. 

Name and describe the surgical operation for cleft 
palate. 

The operation proposed by Brophy, of Chicago, promises 
to revolutionize the treatment of cleft palate. 

He prefers operating at the third month. Observing all 
antiseptic detail, the mucous membrane at the margin of the 
cleft is divided and all of the soft tissues are elevated from 
the hard palate, including the periosteum. The edges of the 
cleft are then pared throughout the entire length of the soft 
palate and the membranes at the distal surface of the hori- 
zontal plates of the palate bones are divided. This allows the 



160 ORAL SURGERY. 

soft parts to fall together and obviates the necessity of mak- 
ing lateral incisions into or through the palate. Four tension 
sutures of silver wire No. 22 are now introduced and their 
extremities are passed through lead plates. These lead plates 
(No. 22 American gauge), are perforated with holes, cor- 
responding to the number of sutures, and extend from the 
anterior margin of the fissure to the distal border of the soft 
palate and are moulded to conform to its shape. Before the 
lead plates are fixed in place, coaptation sutures of silk are 
introduced into the margins of the cleft but are not tied until 
the edges of the cleft have been approximated by the tension 
sutures and lead plates. Immediate union should be secured. 
If the patient is older and the bones have commenced to 
harden, Brophy thoroughly removes the edges of the fissure 
and trims the opposing edges of the bones. The cheek is 
then raised and a strong special needle threaded with a large 
braided silk ligature is passed through the substance of the 
bone to the central fissure. The needle is introduced just 
back of the malar process and high enough to insure its pas- 
sage above the palate bone. An opposite needle now carries 
a corresponding suture through the opposite side, one loop is 
threaded into the other, and one loop may thus be carried 
through both maxillary bones. Silver wire No. 20 is now 
threaded into the loop of silk and drawn through both bones. 
In a similar manner a second wire suture is passed nearer 
the anterior portion of the maxilla above the palatal plate. 
Two lead plates (No. 17 American gauge) are now made to fit 
the buccal convexity of the bone and are perforated for the 
reception of the silver sutures. Upon each side the posterior 
suture is twisted with the anterior suture until the bones are 
approximated. If the bones do not come together a horizontal 
section of the malar process is made upon each side, when 
the bone can be readily moved toward the median line. Any 
irregularities of the cleft may be closed by a few coaptation 
sutures of silk, but this is not usually necessary. 

a. How is a simple cyst in soft tissues differentiated 



ORAL SURGERY. 161 

from other tumors? b. What surgical measures are nec- 
essary to prevent its recurrence? c. Are cystic growths 
classified as benign or malignant? 

a. A cyst is characterized by an absence of inflammatory 
symptoms, unless it is inflamed. Fluctuation is present aud 
the hypodermatic needle reveals a non-purulent fluid. A 
superficial cyst can be better outlined than is the case with 
an abscess. 

b. The complete removal of the cyst wall. 

c. Cystic growths are classified as benign. 

a. Give diagnosis of necrotic alveolar process, b. What 
important condition of the diseased bone should be deter- 
mined before operating? c. Outline the operation. 

a. There will usually be one or more sinuses which lead 
down to sequestra. Necrosed bone can be readily recognized 
by the hard and rough sensation communicated by the probe. 

b. No operation should be performed until the sequestrum 
has become detached. 

c. Make an incision down to the bone in the line of the prin- 
cipal cloacae. Two or more of these are united by sawing 
through the invaginating bony tissue with a Hey's or Gigli 
saw and the sequestrum is freely exposed. The sequestrum 
may now be withdrawn entire, or, if necessary, sawn in two 
and each half extracted separately. The cavity should be 
thoroughly irrigated and packed with antiseptic gauze. 

a. In a case of accidental obstruction of the glottis with 
strangulation and death impending, what should be done 
to save the life of the patient? b. Give details of pro- 
cedure. 

a. Tracheotomy. 

b. The patient is placed in the dorsal position with the 
head extended and held in such a position that the median 
line of the face will correspond to the median line of the 
neck. An incision about two inches in length is made in the 
median line, from below upward, and terminating at the thy- 

11 



162 ORAL SURGERY. 

roid cartilage. This incision divides the skin and superficial 
fascia. The anterior jugular veins, lying to either side of the 
median line, should be avoided by cutting between them and 
drawing them aside. The deep cervical fascia is next divided, 
the interval between the pretracheal muscles recognized, and 
the wound deepened by blunt dissection. The pretracheal 
fascia is now divided and the isthmus of the thyroid gland 
drawn downward. After hemorrhage has been checked and 
the tracheal rings exposed, the trachea is steadied (by a tena- 
culum if possible) and two or three rings are divided from 
below upward. The edges of the tracheal wound are then 
held apart. The wound and surrounding area should now 
be rendered as aseptic as possible, a suitable tracheotomy tube 
procured and inserted, and an antiseptic dressing applied. 

What facial and oral tissues are usually attacked by 
epithelioma? 

The lip and the tongue are the parts most commonly 
affected, but any portion of the epithelial surface (such as 
the gums or the buccal parieties) may be attacked. 

How may a foreign body be removed from the posterior 
nasal passages when lodged beyond the reach of tweezers 
or forceps? Example — a grain of corn, bead, or button. 

The foreign body can generally be pushed down into the 
pharynx by a probe introduced into the anterior nares. 
Care should be taken that it is not inhaled into the larynx 
or trachea or swallowed. 

In some cases it may be possible to dislodge it by the use 
of the Politzer bag or by syringing. Sajou's method may be 
tried — it consists of drawing a cotton or wool tampon through 
the nasal passage from behind. It may be necessary to first 
break up the foreign body by drilling. 

What is the treatment for the relief of empyema of the 
antrum when the teeth are sound and in place? 

The establishment of efficient drainage and thorough irri- 
gation of the cavity of the antrum. A sufficiently large open- 



ORAL SURGERY. 163 

ing should be made in the anterior wall of the antrum in the 
region of the canine fossa. The cause of the disease should 
also receive appropriate treatment. 

Give the etiology and characteristics of suppurative in= 
flammation. 

From a clinical standpoint all suppurative inflammations 
are due to the presence of pyogenic bacteria, which may gain 
access to the affected part through a wound or through the 
circulation. 

When an inflammation terminates in suppuration, the pain 
is at first dull and aching, and then assumes a throbbing 
character. The hard and brawny swelling becomes soft and 
fluctuating in the center and the overlying skin is ede- 
matous. The swelling also becomes more localized than in 
simple inflammation and the redness assumes a dusky hue. 
The constitutional symptoms of impending suppuration are 
the occurrence of a rigor or merely a sensation of chilliness, 
sweating, and a sharp rise of temperature. 

Describe the intermittent pulse, the thready pulse, and 
the hard pulse. 

An intermittent pulse is one in which a beat is occasionally 
missing while the pulse, in the intervals, is perfectly regular. 

The thready pulse is one of low tension and the artery can 
be palpated only during the beat. 

The hard pulse is one of high tension and the artery is full 
between the beats and can be rolled beneath the finger. 

Mention the disinfecting lotions used for surgical irri- 
gations. 

Solution of bichloride of mercury (1-4000) and of car- 
bolic acid (1-100) are the ones usually employed. Mention 
might be made of lysol, creolin, salicylic acid, boric acid, 
hydrogen peroxide, potassium permanganate, oxalic acid, and 
chlorin water. 

State what the elevation of the body temperature dur- 



164 ORAL SURGERY. 

ing the treatment of fractures of the maxillae indicates. 
Give treatment. 

If the rise of temperature is not marked it is simply a con- 
comitant of the healing process and requires no special treat- 
ment. If the fracture is compound the most rigid asepsis 
possible should be observed. 

A considerable rise of temperature accompanied by a rigor 
or a chilly sensation and throbbing pain indicates the for- 
mation of pus. The treatment would naturally consist in the 
evacuation of the pus, free drainage and the maintenance of 
the parts in as aseptic a condition as possible. 

Give the etiology, pathology, and treatment of chronic 
alveolar abscess. 

Practically all cases of alveolar abscess are due to carious 
teeth. 

The pathology is that of any chronic abscess in bone. First 
we have an osteitis and the inflammatory exudate, instead of 
becoming vascularized and converted into new tissue, breaks 
down ; its cells perish from malnutrition, degeneration occurs, 
and suppuration is the result. 

While the abscess may be reached through the alveolus, the 
best method is to extract the tooth, thus removing the original 
cause and securing drainage. In obstinate cases the abscess 
cavity should be curetted and packed with iodoform gauze. 
If a fragment of necrosed bone is present it must be removed 
to secure closure of the sinus. 

State the method of arresting hemorrhage from the in- 
ferior dental canal. 

By plugging the bleeding-point with Halsted's "gut wool," 
or with Horsley's antiseptic wax (beeswax seven parts, al- 
mond oil one part, and salicylic acid one part). 

Give the etiology, diagnosis, and prognosis of carcinoma 
of the mucous membrane of the buccal cavity. 

The etiology of carcinoma of the buccal mucous membrane 
is as obscure as is that of carcinoma in general. A predis- 



ORAL SURGERY. 165 

posing cause may be furnished by continual irritation such 
as the edge of a carious tooth or the taking of hot foods or 
undiluted spirits. 

The affection may commence as an ulcer or fissure, as a 
papilloma, or as a nodule, but in nearly all eases it is char- 
acterized by the early occurrence of ulceration and the ulcer- 
ated surface is surrounded by an indurated everted margin. 
Pain is not present early in the disease, but may prove a 
valuable factor in the diagnosis. The neighboring lymphatic 
glands may be involved. The age of the patient will usually 
furnish an additional aid. 

The prognosis is guardedly favorable if the growth can be 
entirely removed. If a complete operation is impossible the 
prognosis is absolutely unfavorable. 

Mention the rules necessary for surgical cleanliness. 

The entire field of operation, and the hands of the operator 
should be rendered as aseptic as possible. 

The instruments, sponges, sutures, ligatures and everything 
coming in contact with the wound should be sterile. 

Free drainage should be provided if much exudation is ex- 
pected in the wound. 

After the operation the wound should be kept as aseptic as 
possible either by sterile occlusive dressings or by irrigation 
with antiseptic solutions according to the exigencies of the 
case. 

Describe (a) a quick pulse; (b) a feeble pulse; (c) an 
irregular pulse. State what each indicates. 

(a) The term "quick pulse" is ambiguous. According to 
Broadbent, the word quick is capable of two applications in 
this connection since it may apply either to the rate at which 
the beats follow each other or to the character of the indi- 
vidual beats. A "quick pulse" may consequently mean either 
a frequent pulse or one in which the individual pulsations are 
of short duration. A frequent pulse may be due to septic 
infection. A pulse in which the individual beats are of short 
duration is due to diminished intervascular tension. 



166 ORAL SURGERY. 

(b) A feeble pulse is one that is weaker than normal and 
usually indicates cardiac insufficiency. 

(c) An irregular pulse is one in which the beats follow 
each other at regular intervals and are unequal in force. 
If of occasional occurrence it indicates reflex disturbance of 
the cardiac rhythm, gastric derangement with or without 
flatulence, or other functional affections. If permanent in 
character it may indicate cardiac disease, affections of the 
respiratory organs, or the abuse of tobacco, tea, &c. 

Describe the operation of removing a benign tumor. 

A lipoma of the back will be selected as an example. After 
all aseptic precautions have been observed, an incision is made 
over the tumor extending down to its capsule. The fatty 
tumor and its capsule are then enucleated, usually by blunt 
dissection, all hemorrhage checked, the edges of the wound are 
united by sutures, and an aseptic dressing is applied. 

Describe the operation of removing a malignant tumor. 

We operate just as in the case of the benign growth but 
the incisions must be carried wide of the tumor and well into 
the surrounding healthy tissue. If neighboring lymphatic 
glands are involved they must be removed in continuity with 
the growth and no incision is to be made across the interven- 
ing lymphatic channels. The primary object is the complete 
removal of the tumor and the closure of the wound is of 
secondary importance. If a great deal of skin must be sacri- 
ficed the wound may be closed by sliding one or more flaps 
over it or by skin grafting. A rigid aseptic technique should 
be observed. 

Give the etiology, clinical appearance, and treatment of 
smoker's patch of the tongue. 

Smoker's patch is the stage of chronic superficial glossitis 
which is known as leukoplakia. It is due to an inflammation 
of the mucous membrane causing an overgrowth of epithelium, 
which becomes heaped up into rough, dry, horny patches. 



ORAL SURGERY. 167 

The inflammation may be caused by excessive, smoking, the 
drinking of undiluted spirits, the ingestion of highly seasoned 
foods, syphilis, or a combination of several of these causes. 

The treatment is unsatisfactory as far as cure is concerned. 
The exciting factor should be removed and the patch care- 
fully watched for signs of commencing malignancy. The diet 
should be bland, sterile, and unirritating, and after each meal 
the teeth should be brushed and the mouth rinsed out with 
some mild antiseptic solution. No local applications should 
be made. Appropriate constitutional treatment should be in- 
stituted in syphilitic cases. 

Differentiate shock and syncope. 

Shock may be defined as the immediate constitutional effect 
of an injury. "It is that state of general depression of the 
vital activity which occurs after severe injuries, especially 
where there has been violent stimulation of the peripheral 
nerves and nerve-endings, but may be induced also by some 
powerful impression applied to nerve centers" (Pick). 

Syncope is a state of suspended animation, due to sudden 
failure of the heart's action, producing anemia of the brain. 
It may .occur without injury and be produced by the emo- 
tions, intrinsic cardiac conditions, depression of the heart 
from hunger or exhaustion, or by a sudden loss of blood. 

Differentiate carcinoma of the tongue and gummatous 
ulcer of the tongue. 

Carcinoma. Gummatous ulcer. 

Always single. May be multiple. 

Usually in the anterior half and Chiefly far back on the dorsum, 
at the side of the tongue. Other syphilitic lesions may be 

present in the month. 

Lymphatic glands usually involved. Lymphatic glands rarely involved. 

Painful. Painless. 

Induration follows ulceration. Induration precedes ulceration. 

Everted ragged edges. Sharp-cut edges. 



168 ORAL SURGERY. 

There may be a history of preced- History of preceding syphilis. 
ing chronic superficial glossitis. 

Patient usually past 40. May be younger. 

Does not improve on potassium Improves rapidly on potassium 
iodide. iodide. 

The microscope may determine the diagnosis in doubtful 
cases. Both carcinoma and gumma are much more frequent 
in males than females (5 to 1). 

Describe the symptoms of syncope that may occur dur- 
ing the administration of chloroform. Give treatment. 

Sudden cessation of the pulse, sudden dilation of the pupil, 
blanching of the face, and secondary failure of respiration. 

Treatment. — Stop the anesthetic. Invert the patient. An 
assistant should administer a hypodermatic injection of ether 
followed by one of strychnine and the operator should com- 
mence artificial respiration as soon as possible, care being 
taken that the tongue is held well forward to allow the air 
to enter the lungs. 

Give the etiology, diagnosis, and treatment of ulcer. 

The causes of ulceration are either constitutional or local. 

The constitutional causes all act by producing an impair- 
ment of vitality. These causes are senility, deficient innerva- 
tion, and diseases which induce malnutrition such as scurvy, 
diabetes, tuberculosis, and syphilis. 

The local causes are either interference with the circulation 
of a part or some irritation applied to a part. 

Diagnosis. — An ulcer is a solution of continuity of the skin 
or mucous membrane due to molecular or particulate death 
of the part. 

Treatment. — The constitutional treatment is that of the 
underlying disease or condition of malnutrition. It may be 
said in general that the local treatment consists of the re- 
moval of the cause and the maintenance of the ulcer in as 
aseptic a condition as possible; it will naturally vary with 
llif particular variety of ulcer. 



ORAL SURGERY. 169 

Describe (a) a frequent pulse; (b) a soft pulse. State 
what each indicates. 

(a) A frequent pulse is one which beats more rapidly than 
that of the average healthy individual. It may be due to 
idiosyncrasy, the action of drugs, or almost any departure 
from a normal state of health. 

(&) A soft pulse is one in which there is no increase of the 
intravascular tension. It may be felt in health. 

Give the etiology and treatment of acute infectious 
osteomyelitis of the inferior maxilla. 

Acute infectious osteomyelitis of the inferior maxilla may 
result from infection from without (as in a compound frac- 
ture) or from infection from within (hematogenous infec- 
tion) . Various micro-organisms may be responsible, such as 
staphylococci, streptococci, typhoid bacilli, and the bacillus 
coli communis. 

The treatment should be early and energetic. It consists 
of making a large opening in the mandible and scraping out 
all of the diseased marrow. The medullary cavity should 
then be irrigated by strong solutions of bichloride of mer- 
cury (1-1000) and packed with iodoform gauze. 

State the complication that may arise from a compound 
fracture of the inferior maxilla. Give treatment. 

Acute infectious osteomyelitis. See answer to preceding 
question. 

Give the etiology, the pathologic anatomy, the consti= 
tutional symptoms, and the treatment of necrosis of the 
maxilla. 

Necrosis is practically always due to arrested circulation in 
the bone. This may result from injury, as when the perios- 
teum is torn away in a compound fracture. In ostitis the 
vessels may be compressed by the exudate in the Haversian 
canals and in acute periostitis and osteomyelitis the nutritive 
supply may be entirely destroyed and extensive necrosis re- 



170 ORAL SURGERY. 

suit. Necrosis of the jaw may also occur from exposure to 
the fumes of phosphorus or as the result of mercury when 
given to excess. 

Pathologic Anatomy. — Where the necrosis is due to injury 
and only the outer laminae perish we speak of peripheral 
necrosis. If there is a limited inflammation of the cancel- 
lous tissue, usually tubercular, which leads to the death of a 
portion of the bone, as in chronic abscess, we speak of central 
necrosis. 

If the entire thickness of the bone is destroyed, as in cases 
of panosteitis, the term total necrosis is applied. 

The portion of dead bone is called a sequestrum. The peri- 
osteum surrounding a sequestrum deposits new bone and so 
forms an involucrum or invaginating sheath about the dead 
tissue. In this involucrum are a number of openings or clo- 
acae which allow the pus to escape externally through sinuses 
in the soft parts. Where the periosteum has been torn away, 
resulting in peripheral necrosis, an invaginating sheath is 
not formed but the sequestrum is cast off by exfoliation. 

The constitutional symptoms vary according to the amount 
of tissue involved and the nature of the infection. If the 
necrosis is peripheral the only constitutional symptom may 
be a slight rise of temperature ; but if it be total, as in cases 
of acute osteomyelitis, the patient is violently ill, and chills, 
hyperpyrexia, and profuse sweating are observed. 

The treatment consists of the removal of the sequestrum as 
soon as it has become loosened, the disinfection of the remain- 
ing cavity, and tamponade with iodoform gauze maintaining 
the parts in as aseptic a condition as possible and support- 
ing the general health by appropriate measures. In cases of 
acute osteomyelitis, we do not wait for the sequestrum to form 
but clean out the medullary cavity at once as previously de- 
scribed. 

Give the etiology, the pathologic anatomy, and the 
microscopic appearance of acute local periostitis. 

Acute local periostitis is usually the result of injury, but 



ORAL SURGERY. 171 

may also be due to extension of an inflammation from the 
surrounding parts (example periostitis of the jaw from alveo- 
lar abscess) . It may also result from constitutional diseases 
such as tuberculosis or syphilis, and may follow acute rheu- 
matism, typhoid fever, scarlet fever, or measles. 

Pathologic Anatomy. — The periosteum is swollen and red ; 
its deeper layers in particular are infiltrated by inflammatory 
exudate which accumulate between the peiuosteum and the 
bone. The swelling produced in this manner is known as a 
periosteal node. 

The microscopic appearance is that of any acute inflamma- 
tion. The vessels are distended and tortuous and the tissues 
are infiltrated with small round cells. If the disease has 
lasted some time areas of necrosis may be observed. 

Give the etiology and pathologic anatomy of caries of 
the maxillae. 

Caries is usually a tubercular affection but may be due to 
other conditions. It may occur upon the surface of a bone 
beneath a subperiosteal gumma. It may also be the result of 
a non-tubercular rarefying ostitis where the entire bony struc- 
ture is absorbed and converted into granulation tissue. 

Pathologic Anatomy. — As a result of hyperemia and the 
outpouring of an inflammatory exudate, the Haversian canals 
and trabecular spaces become crowded with granulation tissue 
which may show the characteristic structure of tuberculous 
disease. Some of these cells destroy the walls of the Haver- 
sian canals, forming the so-called Howship's lacunae. The 
cells situated within these lacunae are known as osteoclasts. 
The remainder of the granulation tissue undergoes caseation, 
and this form of caries is called caries suppurativa. When 
the granulation tissue destroys the bone and then becomes 
absorbed, instead of undergoing caseation, we speak of caries 
sicca. If the granulation tissue is excessive and the destruc- 
tion of bone is rapid so that it fungates into a joint or be- 
neath the skin, the name of caries fungosa is applied. In 
some instances the granulation tissue dies before it absorbs 



172 ORAL SURGERY. 

and replaces the bone. In such a case a mass of bone may 
be cut off from its nutritive vessels and die en masse when 
we speak of caries necrotica. 

Describe the character of the pain in trifacial neuralgia. 
State the location of pain when each of the three divisions 
is affected. 

The pain of trifacial neuralgia is paroxysmal and may be 
burning, darting, or lancinating in character. The skin may 
be exquisitely tender, particularly at certain points along the 
course of the nerve, the so-called tender points. The pain 
may sometimes be preceded by a tingling sensation, and is 
usually limited to a certain group of nerves upon one side 
of the face. It may sometimes be relieved by pressure. 

When the ophthalmic division is affected the pain is located 
in the forehead, orbit, and nose. 

When the superior maxillary division is affected the pain 
is located in the lower lid, in the side of the nose, in the lip, 
in the upper jaw, in the roof of the mouth, and in the upper 
teeth. 

When the inferior maxillary division is affected the pain 
is located in the ear, in the temporal region, in the lower jaw, 
and in the lower teeth. 

Give the symptoms and treatment of syphilitic perio= 
stitis. State the pathologic changes that may occur in 
syphilitic periostitis. 

In the early stages of secondary syphilis there may be ach- 
ing pains in the superficial bones and their surfaces may 
exhibit swellings which are very tender to the touch. The 
temperature of the patient is slightly increased. This form 
of periostitis soon disappears under the administration of 
mercury, to which it is well to add some iodide of potassium, 
which generally relieves the pain immediately. 

In the later stages of secondary syphilis a single periosteal 
node may appear upon one of the superficial bones. It is 
accompanied by aching pain, which is always worse when the 



ORAL SURGERY. 173 

patient is warm in bed. The treatment consists of the ad- 
ministration of iodide of potassium. 

The pathologic changes that may occur in syphilitic peri- 
ostitis are caries, necrosis, the formation of gummata, and the 
formation of new bone. 

Give the etiology and symptoms of salivary calculus. 

Mixed saliva contains a certain percentage of calcium salts 
which are held in solution by carbon dioxid. Lactic acid fer- 
mentation is so common in the human mouth as to be almost 
a characteristic. This lactic acid coagulates the mucin; the 
calcium salts are precipitated by the escape of their solvent, 
carbon dioxide, and become entangled in the mucin coagulum. 
It is stated that coagulation of the mucin is not necessary to 
bring about this condition of affairs but that its inspissation 
is alone sufficient. 

Symptom. — The calculi are found upon the surfaces of the 
teeth, particularly opposite the mouths of salivary glands; 
beneath the margins of the gums, and in the ducts of the 
muciparous salivary glands (sublingual and submaxillary). 
The symptoms in general are those of a persistent foreign 
body in contact with a vital tissue. 

Give the etiology, pathology, and treatment of acute 
alveolar abscess. 

Acute alveolar abscess is practically always the result of 
decayed teeth. 

The most superficial variety is known as "gum-boil." The 
deeper varieties commence at the apex of a decayed fang. 
The pus may perforate the alveolar wall (or pass over its 
edge) and form a localized collection beneath the periosteum, 
which may ultimately lead to necrosis of the jaw. 

In the upper jaw the affection may cause empyema of the 
maxillary sinus or burrow along the hard palate; in the 
lower jaw it may point on the cheek or at the lower margin 
of the bone. 

The treatment consists of removing the offending tooth and 



174 ORAL SURGERY. 

establishing free drainage. In some cases drainage may be 
secured by drilling through the alveolar process, but it is 
not a satisfactory method in general, owing to the difficulty 
of locating the particular fang involved. In the very super- 
ficial forms of acute alveolar abscess the tooth may be saved. 

Give the etiology of acute arthritis. 

Acute arthritis may begin in the synovial membrane as a 
rheumatic synovitis, as a septic synovitis (from the introduc- 
tion of septic material from without through a wound), or 
as an infective synovitis (from the introduction of organisms 
from within through the blood) . It may also result from 
disease of the contiguous soft parts (as in suppurative bur- 
sitis, phlegmonous erysipelas) or from disease of the neigh- 
boring bones (as in the acute arthritis of infants). 

Give the treatment of aseptic wounds. 

Rest and the maintenance of asepsis by a sterile occlusive 
dressing. 

State the causes of irregularities of the teeth. 

Early extraction of deciduous teeth, delayed loss of decid- 
uous teeth, early extraction of permanent first molar, and 
cleft palate. 

Give the etiology and clinical appearance of salivary 
fistula. 

Salivary fistula may be due to a wound of the cheek divid- 
ing Stenson's duct; the saliva escapes through the opening 
and prevents closure of the external wound. It may also 
result from an abscess of the duct caused by an impacted 
salivary calculus. 

Clinical Appearance. — There is a fistulous opening in the 
cheek which is generally surrounded by a number of small 
granulations. Saliva flows through the fistula as soon as the 
patient commences to eat and produces excoriation of the 
surrounding skin. 



ORAL SURGERY. 175 

Give the etiology, diagnosis, prognosis, and treatment of 
chronic traumatic ulcers of the tongue. 

Chronic traumatic ulcers of the tongue are due to irrita- 
tion from a jagged tooth, a mass of tartar, or the edge of a 
plate. 

The diagnosis is made by the discovery of the exciting cause 
and the exclusion of the other varieties of ulceration. These 
ulcers are usually situated at the side of the tongue opposite 
the offending tooth ; they are ragged and irregular. 

If the ulcer has been present for a long time, slight indura- 
tion may be observed. The glands are not enlarged. The 
diagnosis is confirmed by the healing of the ulcer after the 
removal of the local irritation. 

The prognosis is favorable. 

The treatment consists of the removal of the cause and the 
maintenance of the oral cavity in as aseptic a condition as 
possible. 

State how the different forms of heat may be applied in 
the treatment of inflammation. How does heat affect the 
white blood corpuscles? 

Dry heat may be applied by an india-rubber bag contain- 
ing hot water; by a rubber tube or a Leiter's tube through 
which flows a stream of hot water ; or by the application of a 
flannel bag containing hot salt. 

Moist heat is applied by poultices or fomentations. 

The ameboid movements of the white blood corpuscles of 
mammalian blood are increased by a temperature of 38° C. 
(100.4° F.). Considerable elevations of temperature destroy 
the white blood corpuscles. 

Give the etiology and treatment of cellulitis. 

Cellulitis may be due to infection with the streptococcus 
pyogenes, the bites of snakes, dissecting wounds, and to some 
animal poisons (as those of fetid urine extra vasated into the 
tissues in cases of ruptured urethra) . 

The treatment consists of early and free incisions to afford 



176 ORAL SURGERY. 

a ready exit for the effused products of inflammation. 
Warmth and moisture should be applied in the shape of anti- 
septic fomentations and the part should be kept at rest. The 
constitutional treatment should be supporting in character. 
The diet should be liquid and nourishing. 

Give the etiology and treatment of primary swelling in 
inflammation. 

The swelling in inflammation is due to the engorgement of 
the blood-vessels, to the exudation of the watery elements 
of the blood, and to the transmigration of leucocytes. In the 
so-called third stage of inflammation, this swelling is in- 
creased by the multiplication of the pre-existing connective 
tissue cells of the part. 

The treatment consists of rest, position, the application of 
heat or cold, local depletion, and the other measures pre- 
viously mentioned under the treatment of inflammation in 
general. 

State the effect of local bleeding upon inflamed tissues. 

Local bleeding depletes the inflammatory area, and conse- 
quently diminishes the amount of exudate by decreasing the 
intravascular tension. 

When does secondary hemorrhage occur? Give the 
treatment of secondary hemorrhage. 

At a later period than twenty-four hours after the accident 
or operation. 

Preventive Treatment. — Thorough asepsis, the proper appli- 
cation of ligatures to all bleeding points, and the avoidance 
of the injudicious use of stimulants. 

Curative Treatment. — This will depend upon whether the 
hemorrhage comes from the end of a divided artery (as in a 
stump) or whether it comes from an artery that has been 
ligated in its continuity. Much might be written under this 
head from a surgical standpoint; but as far as dentistry is 
concerned it suffices to say, in a general way, that the treat- 
ment consists in securing the blood-vessels by one or more 



ORAL SURGERY. 177 

ligatures. In mild cases of secondary hemorrhage from the 
■end of a divided artery, elevation, exposure to air, irrigation 
with hot sterile saline solution, and firm bandaging may be 
sufficient. If ligatures cannot be employed on account of the 
septic condition of the tissues, the actual cautery will be of 
service. All septic sloughs should be curetted away, and the 
wound swabbed out with carbolic solution (1-20) or with a 
solution of chloride of zinc (1-12). The wound should then 
be dusted with iodoform crystals, firmly packed with iodo- 
form gauze, and a firm bandage applied. 

State the causes of arrest of development of the maxil= 
lary bones. 

Early extraction of deciduous teeth, early extraction of the 
permanent first molar, ankylosis of the temporo-maxillary 
articulation. 

Describe Angle's method of treating a fractured maxilla 
or mandible. 

Angle's method of treating a fractured maxilla or mandible 
consists of holding the jaws in fixed contact by means of wire 
ligatures wrapped in the form of the figure 8 around buttons 
attached to bands encircling suitable opposite or nearly oppo- 
site teeth. 

This method is not based upon sound principles. A better 
result can always be obtained by wiring. 

Describe the treatment of a single fracture of an eden= 
tulous jaw when the patient has an artificial upper and 
lower denture. 

The upper and lower dentures are to be united (by solder- 
ing or vulcanization as the case may be) and used as an inter- 
maxillary splint. The upper and lower central incisors are 
removed to facilitate the feeding of the patient and external 
support is furnished by a Barton bandage. 

If the patient is a fit subject for anesthesia, such a fracture 
would be better treated by wiring the fragments together. 
12 



178 ORAL SURGERY. 

Give the symptoms and treatment of tubercular peri- 
ostitis. 

Symptoms. In the course of some weeks or months a dif- 
fuse pulpy swelling developes over a bone and this swelling 
is tender to the touch. The skiagram at this time will show 
normal underlying osseous tissue. When caseation occurs 
the swelling becomes more circumscribed but it is more irre- 
gular in shape than an ordinary node. If a tubercular ab- 
scess results, the overlying tissues become indurated, red- 
dened and finally break down when the tubercular matter is 
discharged through the sinus. If mixed infection occur, the 
symptoms are correspondingly aggravated. 

Treatment. Hygienic, dietetic and supporting until either 
caseation or suppuration occurs or until a neighboring joint 
is threatened. If any of these three conditions eventuate a 
free incision should be carried down to the bone, all granu- 
lation tissue and softened bone freely curetted away, the 
cavity disinfected and irrigated, dusted with sterile iodo- 
form crystals, packed with sterile iodoform gauze, and an 
aseptic dressing applied. If a rib be involved complete ex- 
cision of the diseased portion is advisable. 

State at what period of life neuralgia of the fifth nerve 
usually occurs. 

Neuralgia of the fifth nerve is more common during middle 
life. It may be present in advanced life and is very rare in 
children. 

Mention the diseases that may be mistaken for abscess. 

Aneurism, a rapidly growing sarcoma, a cyst, a fatty tumor. 

Give the treatment of actinomycotic periostitis. 

Complete removal of the affected tissue. If inoperable, 
large doses of potassium iodide. 

Give the treatment of shock and collapse resulting from 
severe hemorrhage. 

Intravenous infusion of normal saline solution in addition 
to the ordinary treatment of shock as detailed on page 106. 



ORAL SURGERY. 179 

Give the treatment necessary for rapidly and completely 
healing the cavity of an abscess. 

Early and free incision. The finger should be introduced 
and any existing loculi destroyed after which the cavity is to 
be gently curetted, irrigated, packed with iodoform gauze, 
and made to heal from the bottom. The general principles 
of the local and constitutional treatment of inflammation 
(described elsewhere) should also be carefully applied. 

Mention some of the diseases that may be mistaken for 
empyema of the maxillary sinus. 

Ozaena, hydrops, antral sarcomata. 

Give the symptoms and the treatment of pyemia. 

Symptoms. Pyemia is ushered in with a severe rigor which 
is followed by fever and profuse diaphoresis. The rigors are 
repeated at irregular intervals and although the temperature 
falls between the rigors it never quite reaches the normal. 
The skin is hot and soon takes on an icteroid tinge some- 
times exhibiting erythematous or petechial patches. The 
breath has a sweet mawkish odor which has been compared 
to that of apples or to that of new-mown hay. The tongue 
may be red but is more frequently dry and brown. The pulse 
soon be'comes soft and weak, constipation is present, and noc- 
turnal delirium may be observed although the patient's mind 
usually remains clear to the end. With the deposition of 
each fresh metastatic abscess there is a sharp rise of temper- 
ature accompanied by a chill and followed by free sweating. 
The joints may fill up with pus over night and this without 
causing the patient any local pain whatever. The joints fre- 
quently involved are the knee-joint, the sterno-clavicular 
articulation, and the sacro-iliac synchondrosis. The original 
wound, though it may have been secreting freely, becomes 
dry and glazed. 

Treatment. The focus of infection should be removed as 
freely as possible and all metastatic abscess should be effi- 
ciently drained wherever practicable. The constitutional 



180 ORAL SURGERY. 

treatment should be supporting, consisting of a liquid nutri- 
tious diet, hypodermatic injections of strychnine, and alcohol 
(in the form of whisky) administered with a free hand. In- 
travenous infusion of normal saline solution may be of some 
value. 

Give the symptoms and treatment of rickets. 

Symptoms. The child may be flabby or emaciated. Vo- 
miting and diarrhea are usually present, the evacuations be- 
ing green, slimy and most offensive. The spleen is enlarged 
and the abdomen is protuberant. Particularly characteristic- 
is the sweating about the head. 

The osseous changes are ushered in by increasing irrita- 
bility and restlessness, the child crying out when picked up 
or even touched. The articular ends of the long bones be- 
come enlarged as do also the chondrocostal junctions (" rick- 
ety rosary"). The head is flattened anteroposteriorly so 
that it appears box-like, the fontanelles remain open much 
longer than usual, and dentition is delayed. Kyphosis, scol- 
iosis or a combined curvature of the spine may be present. 
The sternum is pushed forward and the curvature of the 
ribs becomes exaggerated at their angles so that a "pigeon 
breast" is produced. The pelvis becomes either flattened 
(when patient is kept supine) or triradiate (when allowed to- 
walk). The natural curves of the long bones become in- 
creased, particularly at those points giving attachment to 
powerful muscles. Growth is frequently checked by the 
presence of this disease. 

Treatment. Correction of hygienic and dietetic errors. 
Properly modified cow's milk, beef juice, attention to the 
condition of the bowels, and an abundance of fresh air and 
sunshine. Deformities should be prevented by keeping the 
child off his feet; if slight they may be corrected by daily 
manipulation of the affected bones or by braces. Where de- 
formity persists it should be overcome by osteotomy or even 
by resection of the affected portion. 



ORAL SURGERY. 181 

Describe the symptoms of actinomycotic periostitis. 

This disease usually affects the lower jaw, the ray fungi 
gaining entrance to the parts through an abrasion of the mu- 
cous membrane. There is a chronic "board-like" or "wood- 
en" induration of the tissues which subsequently breaks down 
and discharges through sinuses. In the slimy discharge will 
be found characteristic yellow granules which are gritty to 
the touch from their contained lime-salts and which may be 
recognized under the microscope as the aetinomyces. As a 
rule there is little pain and but slight constitutional dis- 
turbance. 

Give the symptoms and treatment of tubercular ab= 
scesses. 

Symptoms. The local symptoms will vary with the par- 
ticular tissue affected. In bone, for example, severe ach- 
ing or boring pain may be experienced in a fixed location at 
one extremity of the shaft. This pain may be absent in the 
day-time. It may be intermittent, disappearing altogether 
to make its reappearance after weeks or months, often with- 
out assignable cause. Tenderness may be elicited. A slight 
enlargement of the bone may be detected and late in the case 
a dusky red area appears over the tender area indicating the 
future formation of a sinus. Constitutional symptoms may 
be entirely absent until caseation occurs when there will be 
an evening rise of temperature. If mixed infection take 
place suppurative fever will result. 

Treatment. Hygienic, dietetic, and supporting until case- 
ation occui-s when the tubercular material should be removed 
as thoroughly as possible, the cavity curetted until healthy 
tissue is reached, after which it should be irrigated and 
packed with iodoform gauze. If the abscess be in a' gland or 
a joint, excision is the ideal method. 



PATHOLOGY. 



What are spores? How may nutrient media be freed 
from spores at a temperature below ioo degrees C? 

Spores are reproductive bodies of lower vegetable organ- 
isms (of bacteria, for example). 

Nutrient media may be freed from spores at a temperature 
below 100° C. by the process of fractional sterilization. The 
nutrient media are exposed to a temperature of 80° C. for 
15 minutes. This destroys the bacteria, and the media are 
then kept at the room temperature for 24 hours so that the 
spores may develop into bacteria. These bacteria are de- 
stroyed by an exposure to 80° C. for 15 minutes upon the 
second day. This process is repeated the third and some- 
times the fourth day, at which time the media will be free 
from spores. 

Define pathology. 

Pathology is that branch of medical science which treats 
of modifications of function and changes in structure caused 
by disease. 

Define leukomains. State where they are found. 

By leukomains are meant any of the nitrogenous bases or 
alkaloids normally developed by the metabolic activity of 
living organisms, as distinguished from the alkaloidal sub- 
stances developed in dead bodies and called ptomains. 

They have been found in almost all of the tissues of the 
body. 

Mention the different kinds of tumors of the gums. 

Simple epulis (fibroma), malignant epulis (myeloid sar- 
coma), round-celled sarcoma, spindle-celled sarcoma, and 
epithelioma. 

(183) 



184 PATHOLOGY. 

State the difference between parasites and saprophytes. 

A parasite is an animal or vegetable organism living upon 
or within another living organism. 

A saprophyte is a vegetable organism living upon dead 
organic matter. 

How may inflammation terminate? 

Inflammation may terminate by resolution, retrogression 
(the formation of cicatricial tissue), suppuration, ulceration, 
or gangrene. 

Name the various tumors of the tongue. 

Papilloma, fibroma, lipoma, myxoma, angioma, lymphan- 
gioma, and epithelioma. Lymphadenoma and lymphosar- 
coma may occur at the root of the tongue. Chondroma has 
also been found in the submucous tissue of the tongue. 

What is the most common syphilitic lesion upon the 
tongue? 
Mucous patch. 
What is inflammation? 

Inflammation is the succession of changes which occur in 
a living tissue when it is injured, providing the injury is 
not of such a degree as to at once destroy its structure and 
vitality (Burdon Sanderson). It is "the response of living 
tissue to injury." 

Define sepsis, asepsis. 

Sepsis is a condition of poisoning produced by the ab- 
sorption of putrefactive substances. 

Asepsis is the absence of pathogenic micro-organisms. 

Give the differential diagnosis between sarcoma and 
carcinoma. 

A sarcoma arises from connective tissue, may occur at any 
age, may be encapsulated, gives metastasis through the blood- 
vessels, and the overlying integument frequently contains 
dilated veins. 



PATHOLOGY. 185 

A carcinoma arises from epithelial tissue, usually occurs 
-after middle life, is never encapsulated, and gives metas- 
tasis through the lymphatic vessels. 

What is the difference between a ptomain and a toxin? 

A ptomain is a basic compound resembling the alkaloids, 
formed during the decomposition of animal or vegetable 
tissues. 

A toxin is any poisonous substance, either albuminous or 
basic, produced by the action of bacteria upon organic matter. 

A toxin is a poisonous ptomain. 

Give the pathology of sarcoma of the superior maxilla. 

Sarcoma originates from the anterior wall or from the 
cavity of the antrum or from the sphenomaxillary fossa be- 
hind the bone. The maxilla may be secondarily involved by 
sarcomatous naso-pharyngeal polypi which extend from the 
nose. These growths frequently contain considerable ossific 
deposits, and this is occasionally so extensive that the antra! 
«avity is obliterated and the bone converted into a solid mass. 

Name tumors of the buccal parietes. 

Papilloma, naevus, cavernous angioma, and epithelioma. 

Mention four forms <yf abscesses. 

Acute or hot, chronic or cold, residual, and metastatic. 

What is an embolus? 

An embolus is a particle of fibrin or other material which 
is swept into the blood current and which is capable of 
forming an obstruction at its place of lodgment. 

What is an aneurism? Mention three varieties. 

An aneurism may be defined as a sac containing blood 
and communicating with the interior of an artery. 
Fusiform, saccular, and dissecting. 

Mention five forms of inflammation. 

Fibrinous, diphtheritic, suppurative, hemorrhagic, and gan- 
grenous. 



186 PATHOLOGY. 

What are the active agents in decomposition? 

The active agents in decomposition are the saprophytic 
bacteria. 

Define pasteurization. How does pasteurization differ 
from disinfection and sterilization? 

Pasteurization is a process of checking fermentation in 
organic fluids by heating them to 60° or 70° C. 

It differs from disinfection, since in disinfection the bac- 
teria are destroyed by the use of chemical agents. 

It differs from sterilization, since in sterilization, the tem- 
perature is carried higher and the bacteria are destroyed, 
whereas in pasteurization the temperature is simply raised 
to a point where few fungi can flourish. 

Give the lesions in syphilitic affections of the buccal 
mucous membrane. 

The initial lesion (chancre) may rarely occur in this situa- 
tion. In secondary syphilis there is often a chronic inflam- 
mation of the buccal mucous membrane and mucous patches 
(irmcous tubercles, condylomata) are not infrequently present. 

State what micro-organisms produce pus. 

Staphylococcus pyogenes aureus, staphylococcus pyogenes 
albus (staphylococcus epadermidis albus), staphylococcus pyo- 
genes citreus, streptococcus, bacillus coli communis, bacillus 
typhosus, pneumococcus, and gonococcus. 

Describe the structure of a bacterial cell. 

The cell is principally composed of an albuminous sub- 
stance known as mycoprotein. There is a large nucleus 
situated in the centre of the cell constituting its great bulk. 
This is surrounded by a very delicate cell-wall. In some 
bacteria, cilia or flagella may be observed extending away 
from the cell-wall. In other bacteria, the cell-wall seems to 
undergo a gelatinous transformation so that the bacteria 
seem to be surrounded by a halo or capsule (pneumococcus). 



PATHOLOGY. 187 

State the difference between benign and malignant 
tumors. 

Benign tumors are usually encapsulated, do not give metas- 
tasis, do not recur upon removal, produce no cachexia, grow 
slowly, do not infiltrate, are not painful (except by pres- 
sure), and do not cause death (except by location). 

Malignant tumors are never effectively encapsulated, give 
metastasis, recur upon removal, produce cachexia, usually 
grow rapidly, infiltrate, are painful, and cause death. 

What is the usual source from which pathogenic bac- 
teria are derived? State the conditions under which 
micro-organisms get into the air. 

Pathogenic bacteria are practically always derived in- 
directly from the bodies of diseased human beings or lower 
animals. They may be inhaled with the air (tuberculosis), 
ingested with the liquids or food (cholera and typhoid), or 
gain access through wounds. 

The micro-organisms get into the air from the soil. The 
excreta of diseased individuals becomes dried, ground up into 
dust, and these dust particles loaded with bacteria are dis- 
seminated by the winds. Micro-organisms rarely pass from 
fluids into the air. 

Describe a method of making gelatine plates. 

Three tubes of sterile gelatine are to be liquefied by heat. 
Tube No. 1 is inoculated with the infectious material by 
means of a platinum wire. Tube No. 2 is now inoculated 
from tube No. 1, and tube No. 3 is inoculated from tube 
No. 2. The contents of these tubes are now poured into 
three previously sterilized Petri dishes. In all of these 
manipulations, precautions must be taken to avoid accidental 
contamination of the culture medium. 

Differentiate thrombosis and embolism. 

By thrombosis is meant a clotting of the blood within the 
heart or blood-vessels. It is due to a slowing of the current, 
or to an altered condition of the blood or blood-vessel walls. 



188 PATHOLOGY. 

By embolism is meant the obstruction of a blood-vessel 
(particularly an artery) by a fragment of matter brought 
from another point. This fragment of matter or embolus 
may be a detached piece of a thrombus. 

How does suppuration spread? 

Suppuration spreads by the peptonization of the inflam- 
matory exudate by the pyogenic cocci. It spreads in the 
direction of least resistance. 

State the usual method of cultivating bacteria. 

The usual method of cultivating bacteria is to inoculate 
any of the ordinary culture media with the bacteria in ques- 
tion, and then to keep the media under conditions favorable 
for the growth of the micro-organisms. Bouillon, agar agar, 
potato, etc., may be kept in the brood-oven ; gelatine is kept 
at room-temperature. 

Define oral pathology. 

Oral pathology is the study of the modifications of func- 
tion and changes in structure as they occur in the mouth 
and adjacent parts. 

Mention the principal diseases of the maxillary bones. 

Osteomyelitis and its sequelae, alveolar abscesses, peri- 
ostitis, tuberculosis, syphilis (gummata), osteoma, chon- 
droma, fibroma, myxoma, carcinoma, sarcoma, and empyema 
(upper jaw). 

Describe the histologic structure of carcinoma. 

The structure will vary according to the region involved. 
The tumor is made up of epithelial cells and a stroma of 
connective tissue. In epithelioma of the skin, the cells are 
of a squamous type ; in carcinoma of mucous membranes, they 
are cylindrical and there is a tendency to the formation 
of cuboidal epithelium. The cells show secondary changes 
(dropsical infiltration, mucoid degeneration, fatty degenera- 
tion, etc.). Karyokinetic figures may be abundant and are 
frequently atypical. 



PATHOLOGY. 189 

The epithelial cells are usually grouped into acini or into 
alveoli containing several layers of epithelial cells. At the 
periphery of the acini, the cells may break through the base- 
ment membrane. 

The connective tissue stroma is of varying density, but is 
always of a fibrous character. It is arranged so as to form 
hollow spaces which contain the epithelial cells. 

What are the active causes of carcinoma of the buccal 
cavity? 

Any irritation, such as smoking, a sharp tooth, the stem 
of a pipe, or a badly-fitting plate. Leukoplakia, chronic 
glossitis, and probably caustics. 

What is the cause of pain in inflammation? 

The pain in inflammation is caused by the exudate stretch- 
ing and pressing upon the filaments of the sensory nerves. 
Another factor in the production of inflammatory pain is the 
chemical irritation of the sensory filaments by the toxins 
produced by the bacteria. 

What is the difference between catarrhal and suppuua= 
tive inflammation? 

In catarrhal inflammation there is usually considerable 
liquid exudation, retention cysts may form in the mucous 
glands, and even localized erosions may appear. There is a 
hypersecretion of mucus and a desquamation of epithelium. 

In suppurative inflammation, the exudate contains a large 
amount of leukocytes, which are killed and transformed into 
pus cells. 

What is periostitis? 

Periostitis is an inflammation of the periosteum. 

What is provisional callus, and where is it found? 

Provisional callus is the temporary splinting-material which 
nature throws out about the ends of fractured bones. 

It is found outside of the ends of the fragments (ring 



190 PATHOLOGY. 

callus) and within the medullary cavities of the fragments 
(pin callus). 

Give some of the pathologic and anatomic character- 
istics of a benign tumor. 

Benign tumors usually resemble the tissue from which they 
grow, tend to unlimited growth, are encapsulated, do not 
adhere to surrounding structures, do not infiltrate, do not 
give rise to metastasis, do not recur when thoroughly re- 
moved, have a nutrition which is independent of the general 
nutrition of the body, and do not cause death (except mechan- 
ically). 

What is meant by intermediate or definitive callus? 
Where is it found? 

Definitive callus is the callus which ultimately unites the 
fragments of fractured hone. It is the metamorphosis of 
this tissue that results in bony union. 

It is found between the ends of fractured bones. 

What effect has increased nutrition on tissues? 

It may result in fatty infiltration, in more rapid growth, 
or in hypertrophy. 

What effect has imperfect nutrition on tissues? 

It causes tbem to degenerate and atrophy. 

Differentiate between syphilitic and congenital cleft 
palate. 

Syphilitic perforation is practically always due to a broken- 
down gumma. There will be a history of preceding syphilis 
and concomitant lesions in some portion of the body. The 
perforation will have been accompanied by marked inflam- 
matory symptoms, well remembered by the individual. 

Congenital cleft palate is present at birth and is due to 
a failure of union of the two palatal processes. 

Differentiate fibrous from sarcomatous epulis. 

Fibrous epulis grows slowly, is hard, painless, pale-red, 
and rarely attains a larger size than that of a walnut. 



PATHOLOGY. 191 

Sarcomatous epulis grows rapidly, is softer, painful, livid 
in color, ulcerates sooner, and may attain the size of an apple. 

Mention the tumors of the buccal cavity. 

Fibroma, lipoma, myxoma, chondroma, osteoma, lympha- 
denoma, lymphosarcoma, spindle-celled sarcoma, myeloid sar- 
coma, papilloma, and carcinoma. 

Define abscess. State of what the walls of an abscess 
consist and describe its growth. 

An abscess is a circumscribed collection of pus in a cavity 
of abnormal formation. 

The walls consist of granulation tissue. 

The vessels of the affected area become dilated and the 
various elements of the blood pass through the walls. As the 
pyogenic organisms develop, retardation and stasis followed 
by thrombosis occur successively, whilst the exudation of cells 
becomes so great that the original tissue of the part disap- 
pears, after passing through a stage of coagulation necrosis. 
This removal of the infiltrated tissues is largely caused by 
their liquefaction, owing to the peptonizing power of the 
bacteria. 

State how a dead pulp may cause empyema of the max- 
illary sinus. 

The dead pulp may become infected and give rise to an 
alveolo-dental abscess, which ruptures into the maxillary sinus 
or causes a purulent inflammation of its lining by contiguity 
of structure. 

Define atrophy. Give the pathologic anatomy of atrophy. 

Atrophy is a reduction in bulk of one or more of the 
component parts of an organ, and the functional activity is 
reduced. 

The organ is reduced in size; its consistency may be in- 
creased; the outline of the organ may become irregular, and 
there is an inci-ease of pigment. The microscope shows a re- 
duction in the size of the individual cells. 



192 PATHOLOGY. 

Give an effective method of sterilizing hypodermic 
syringes. 

The modern hypodermic syringe consists entirely of metal, 
and can be effectively sterilized by boiling it for five minutes 
in a 1% solution of sodium carbonate. 

If boiling water is drawn up into the old glass and metal 
syringe and then ejected, and this is repeated six or eight 
times, the syringe will be practically sterile. This method 
is more reliable than solutions of carbolic acid or bichloride 
(Eiselsberg). 

State in what manner micro-organisms enter the body. 

Through the respiratory tract, through the gastro-intestinal 
tract, through solutions of continuity of the skin and mucous 
membranes, and through the placenta. 

State the difference between asepsis and antisepsis. 

In asepsis, an effort is made to prevent the entrance of 
germs into a wound. The greatest reliance is placed upon 
mechanical purification and upon sterilization by heat- 
In antisepsis, an effort is made to destroy the germs in a 
wound as well as to prevent the entrance of more bacteria. 
The greatest reliance is placed upon chemical agents. 

How and under what conditions do bacteria multiply? 

Bacteria multiply by fission (direct division), and by 
sporulation (development of spores). 

The following conditions are requisite for the multiplica- 
tion of bacteria : 

1. Presence of oxygen (aerobic bacteria). Absence of 
oxygen (anaerobic). 

2. A certain amount of organic matter. 

3. A certain amount of moisture. 

4. A neutral or feebly alkaline reaction, for the majority 
of bacteria. 

5. A temperature above 16° C. and below 40° C. 

6. The majority of bacteria multiply most rapidly when 
the medium in which they grow is at rest. 



PATHOLOGY. 193 

Define antitoxin, virulent germ, non=virulent germ. 

An antitoxin is a counter-poison elaborated by the body 
to counteract, the toxins of bacteria. 

A virulent germ is one having marked pathogenetic prop- 
erties. 

A non-virulent germ is one the pathogenetic properties of 
which are not marked. 

Differentiate hypertrophy and tumor. 

Hypertrophy is an increase in bulk of a tissue or organ 
occurring independently of the general growth of the body. 
In a true hypertrophy the functon is increased. 

A tumor is an atypical new formation tending to unlim- 
ited growth, having no function, differing from the tissue 
in which it is found in gross and minute structure, the nutri- 
tion of which is independent of the nutrition of the body in 
general, and which is not dependent, upon or coincident with 
inflammation. 

What are pathogenic bacteria? State how pathogenic 
bacteria incite disease processes. 

Pathogenic bacteria are those which produce disease. 

After gaining an entrance to the tissues, they may incite 
disease processes in one of the following ways : 

They may grow so rapidly that they completely block up 
the blood and lymphatic channels. 

They may cause a local inflammation, due partly to the 
presence of the foreign organisms and partly to their toxic 
metabolic products. 

More often, however, they produce powerful metabolic 
poisons, which destroy the tissues immediately acted upon, 
or circulate through the organisms and overflow the normal 
physiologic equilibrium. 

Define carcinoma. Give with reference to carcinoma 
(a) congenital theory, (b) traumatic theory, (c) clinical 
appearance. 

A carcinoma is a malignant epithelial tumor, composed of 
13 



194 PATHOLOGY. 

a connective tissue stroma, surrounding groups or nests of 
epithelial cells. 

(a) Congenital theory.— The carcinoma is supposed to 
grow from embryonal rests or " resting spores." 

(b) Traumatic theory. — The carcinoma develops as the 
result of a single traumatism or of repeated irritations. 

(c) Clinical appearance. — The tumor occurs in an indi- 
vidual past middle life, is fixed to the surrounding tissues, 
and may be ulcerated. The neighboring lymphatic glands 
are enlarged, the tumor is the seat of lancinating pain, and 
cachexia is present. 

Distinguish between pathologic regeneration and physi- 
ologic regeneration. 

Physiologic regeneration is that which occurs in the normal 
life of the organism, and by which the cellular wear and 
tear is counterbalanced. The tissue destroyed is replaced by 
similar tissues. 

Pathologic regeneration is the more massive and open 
atypical reconstruction that follows disease or injuries. The 
tissue destroyed is almost always replaced by connective 
tissue. 

What is disinfection? How may the strength of a dis- 
infectant be determined? 

Disinfection is the destruction of micro-organisms, partic- 
ularly by the action of chemicals. 

The strength of a disinfectant may be determined by 
bringing definite quantities of the infected material in con- 
tact with definite quantities of a series of solutions of graded 
strengths, and subsequently making cultures from the in- 
fected material, which has been thus exposed, to determine 
whether the organisms have been completely destroyed. 

How do wounds heal? 

Wounds heal : 

1. By immediate union. 

2. By first intention. 



PATHOLOGY. 195 

3. By organization of a blood clot. 

4. Under a scab. 

5. By second intention (granulation). 

6. By third intention (adhesion of granulating surfaces). 

By the first four methods the wound heals without the for- 
mation of pus; in the last two methods suppuration is 
present. 

Mention the different varieties of tumors of the supe- 
rior maxilla. 

Myxoma, fibroma, chondroma, osteoma, odontoma, sarcoma, 
and carcinoma. 

Define pus. Give the specific gravity and varieties of 
pus. 

Pus is a thick, opaque, creamy fluid ; it is smooth and 
slightly glutinous to the touch, has a faint odor and a slightly 
sweetish taste. It is neutral or feebly alkaline in reaction. 

The specific gravity of pus varies between 1021 and 1042. 

The varieties of pus are : The so-called healthy pus, ichorous 
pus, sanious pus, fetid pus, curdy pus, muco-pus, and sero-pus. 

Define suppuration. 

By suppuration is meant the formation of pus. 

Define diathesis. 

A state or condition of the body whereby it is especially 
liable to certain diseases. It may be acquired or hereditary. 

Define cachexia. 

A depraved condition of general nutrition due to some 
serious disease, such as syphilis, tuberculosis, carcinoma. 

Into what classes are bacteria divided? 

According to their morphology, bacteria are divided into : 
(1) Cocci, (2) Bacilli, (3) Spirilla. These are relatively 
monomorphous. Three other varieties might be mentioned : 
(4) Spirulina, (5) Leptothrix, (6) Cladothrix. These are 
relatively pleomorphous. 



196 PATHOLOGY. 

Define plethora, anemia, hyperemia. 

By plethora is meant an increase of the total amount of 
the blood in the body. 

By anemia is meant a deficiency of the blood as a whole, 
a deficiency of the red corpuscles, or of the hemoglobin. 

By hyperemia is meant an increased amount of blood in 
the more or less dilated vessels of a part. 

Describe (a) local hyperemia; (b) passive hyperemia. 

All hyperemias are local. By hyperemia is meant an in- 
creased amount of blood in the more or less dilated vessels 
of a part. 

By a passive hyperemia is meant an increased amount of 
blood in the more or less dilated veins and capillaries of a 
part with diminished velocity of the blood stream. The part 
is bluish and swollen. Nutrition, function, and temperature 
are all decreased. 

Define hemorrhage. 

By hemorrhage is meant the escape of the several con- 
stituents of the blood from the blood-vessels. 

What is meant by chromogenic and pyogenic bacteria? 

Chromogenic bacteria are those which produce colored 
colonies or impart color to the medium in which they grow. 
Pyogenic bacteria are those capable of producing pus. 

What is a culture medium? What is a pure culture? 

A culture medium is a mixture in which it is possible to 
cultivate bacteria. 

A pure culture is a culture of a single species of bacteria. 

What are toxalbumins? 

Toxalbumins are toxic substances produced by either ani- 
mal or vegetable cells. They are albuminous in character, 
giving the ordinary reactions for albumin. 

Distinguish between cocci, bacilli, and spirilla. 

Cocci are bacteria having a spherical shape. 



PATHOLOGY. 197 

Bacilli are elongated or rod-shaped bacteria. 
Spirilla are bacteria having a spiral shape and bear some 
resemblance to a cork-screw. 

State why the mouth is a favorable place for the de- 
velopment of bacteria. 

Because heat, moisture, oxygen, and decomposing organic 
matter are constantly present. 

Name the classification of cocci from the number and 
order of arrangement of the cells. 

Diplococci, tetragenococci, merismopedia, sarcina, strep- 
tococci, streptodiplococci, and staphylococci. 

Differentiate between aerobic, anaerobic, and facultative 
bacteria. 

Aerobic bacteria are those which grow in the presence of 
oxygen. 

Anaerobic bacteria are those which do not grow in the 
presence of oxygen. 

Facultative bacteria are those which grow either with or 
without oxygen. 

Define general pathology; special pathology. 

General pathology is the study of morbid processes in gen- 
eral without reference to the individual organs. 

Special pathology is the study of morbid processes in the 
individual organs. 

State what is meant by (a) the predisposing cause of 
disease; (b) the exciting cause of disease. 

A predisposing cause of disease is one which places the 
individual in a condition favoring the action of the exciting 
cause; it prepares the system or part by rendering it weaker 
and less resistant. 

The exciting cause of disease is the immediate or specific 
cause of the disease. 



198 PATHOLOGY. 

Classify the diseases due to bacteria. 

The following is the classification of McFarland: 

A. The Phlogistic Diseases. 

1. The Acute Inflammatory Diseases, suppuration. 

2. The Chronic Inflammatory Diseases, (a) Tuberculosis; 
(6) Leprosy; (c) Glanders; (d) Syphilis; (e) Actinomy- 
cosis; (/) Mycetoma or Madura-foot; (g) Farcin du Boeuf ; 
(h) Rhinoscleroma. 

B. The Toxic Diseases. (a) Diptheria; (ft) Tetanus; 
(c) Hydrophobia or rabies; (d) Symptomatic anthrax; (e) 
Typhoid fever; if) Cholera; (g) Pneumonia. 

C. The Septic Diseases, (a) Relapsing fever; (fe) Influ- 
enza; (c) Malignant Edema; (d) Measles; (e) Bubonic 
Plague; (/) Tetragenus; (g) Chicken Cholera; (h) Mouse 
Septicemia; (i) Anthrax; (j) Typhus Murium. 

Mention the pathologic changes in gangrenous stom- 
atitis. 

The pathologic changes are those of a rapid necrosis of all 
the tissues; the micro-organisms of suppuration and putre- 
faction ai*e present. Putrefactive changes are always in evi- 
dence; intense septic infection and intoxication are almost 
always observed. 

From what do cysts of the alveolar process arise? 

Dental cysts are inflammatory in their origin and are 
formed in connection with the fang of a tooth. 

Dentigerous cysts arise from imperfectly developed teeth 
which have been retained in the jaw. 

Multilocular cysts may be either fibrocystic tumors or cysts 
developed in adenomatous or sarcomatous tissues. 

\J Describe the process of repair of fractures. 

In a simple fracture the ends of a broken bone and the 
contiguous lacerated tissues are immediately surrounded by 
a clot of blood. As a result of simple traumatic inflamma- 
tion, exudation occurs and the clot is invaded by leucocytes. 



PATHOLOGY. 199 

which absorb it and the damaged tissues. There now occurs 
an infiltration of large plasma cells derived from a multipli- 
cation of the pre-existing connective-tissue cells of the part. 
Vessels grow into this tissue from the surrounding parts so 
that it becomes organized and converted into granulation 
tissue, which is known as callus. The plasma cells destroy 
the emigrated leucocytes and are converted into fibrous tissue, 
which contracts and obliterates the vessel. This scar tissue 
now undergoes calcification and ossification. The intercel- 
lular substance increases in quantity, the cells become an- 
gular, resembling osteoblasts, lime salts are deposited around 
them, and true bone is formed in the same manner as in the 
usual process of ossification. 

Mention and explain the causes of inflammation. 

The predisposing causes of inflammation are those which 
depress the vital powers and render the individual more 
susceptible to the action of the exciting causes. The pre- 
disposing causes of inflammation are hereditary tendencies, 
bad habits, faulty hygiene, and dietetic errors, diminished 
innervation, organic visceral disease, and certain states of the 
blood (such as anemia). 

The exciting causes of inflammation are the immediate or 
specific causes of the inflammation. These are: (1) Direct 
injury (mechanical, chemical physical) ; (2) the chemical 
products of putrefaction; (3) infective micro-organisms. 

What is meant by regeneration of tissue and how is it 
brought about? 

By regeneration is meant the formation of new cells or 
tissues to take the place of those destroyed. 

Physiologic regeneration is brought about by a process of 
gradual cell-multiplication without marked changes of any 
sort. 

Pathologic regeneration is brought about by the process of 
inflammation. 



200 PATHOLOGY. 

Define (a) etiology, (b) morbid anatomy, (c) diagnosis, 
(d) prognosis. 

Etiology is that branch of pathology which treats of the 
causation of disease. 

Morbid anatomy is that branch of pathology which treats 
of the changes of structure and form that take place in 
diseased conditions. 

Diagnosis is the determination of the nature of a disease 
by a study of its symptoms. 

Prognosis is a judgment in advance concerning the dura- 
tion, course, and termination of a disease. 

What pathologic conditions may be caused by an im- 
pacted third molar? 

Hypertrophy of the pericementum, pressure-resorption of 
adjacent roots, the formation of a capsule of new bone about 
the impacted tooth, infringement of the root-apex upon the 
inferior dental vessels and nerve, and necrosis of the bone. 

What is fermentation? What causes it? 

Fermentation is the decomposition of complex molecules 
under the influence of ferments. 

Fermentation is caused by enzymes, yeasts, and bacteria. 

What precautions should be taken to prevent septic in- 
fection? 

The wound or operative area should be made as sterile as 
possible and no septic substance should be allowed to come 
in contact with it subsequently. Asepsis is secured by 
mechanical purification, sterilization by heat, chemical dis- 
infection, or by some combination of the three methods. 

What is the cause of an apical alveolar abscess? De- 
scribe the process of its formation. 

The infection of the pericementum by pyogenic organisms. 
The purulent apical pericementitis is almost always pre- 
ceded by death and putrefaction of the pulp, but consider- 



PATHOLOGY. 201 

able purulent destruction of the pericementum may occur 
near the apex of the tooth and the pulp of the tooth remain 
alive for a short time. In the latter case the path of in- 
fection is unknown, but the pyogenic organisms may be 
carried here by the blood from a distant focus of suppuration. 
An abundant exudate is poured out into the interstices of 
the pericementum, the leucocytes die and form pus cells, the 
exudate is peptonized, and we have all the phenomena of 
abcess formation in other situations. 

What are salivary calculi? What conditions are pro- 
duced by them? 

Salivary calculi are hard concretions composed of the cal- 
cium salts of the saliva which have been precipitated and 
combined with organic substances (usually mucin). 

When situated in the salivary ducts, calculi may cause 
retention of saliva with inflammatory phenomena tending to 
abscess and subsequent salivary fistula. 

When situated upon the teeth, they may cause gingivitis, 
absorption of the gum, destruction of the alveolus, or an 
ulcer of the tongue. 

What is the difference between a tumor and an inflam- 
matory swelling? 

The reader is referred to the definitions of tumor and in- 
flammation given in answer to some of the preceding ques- 
tions. To differentiate these conditions further, it might be 
said that tumors are almost always unaccompanied by fever, 
unless there is some intercurrent infection, and that the tumor 
is not characterized by a local increase of temperature unless 
it is of very rapid growth. The benign tumors do not give 
rise to pain (unless by pressure), and the pain of a malig- 
nant tumor differs in character from that of inflammation. 
The swelling is usually more acute in the inflammation than 
in the tumor. Redness may be entirely absent in the neo- 
plasm. 



202 PATHOLOGY. 

Mention the varieties of pathogenic bacteria found in 
the air. 

The particular variety depends entirely upon the sur- 
roundings. The air of stables is apt to contain tetanus 
bacilli and possibly the bacillus of malignant edema. The 
air of a room in which a tubercular patient is kept may 
contain the tubercle bacillus, particularly if the sputum dries 
and is ground up and disseminated by the dust. The air of 
hospital wards may contain any of the bacteria producing 
infectious diseases or suppuration. 

Describe the characteristics of carcinomatous ulcer. 
Give the cause of putrefaction of carcinomatous ulcer. 

Epitheliomatous ulcers occur in individuals at or past 
middle life. They commence as a wart or fissure and stead- 
ily progress. The base of the ulcer bleeds easily ; it is in- 
durated, uneven, and covered with firm, pink granulations 
containing small, yellow specks. The edges are indurated 
and everted. The neighboring lymphatic glands enlarge 
after a time and become adherent to each other and to the 
overlying skin. Early in the disease the secretion is scanty 
and viscid and pain may be entirely absent. 

If the epithelioma is deep-seated, it commences as a red- 
dish tubercle, which breaks down into an irregular ulcer with 
a foul, bleeding, indurated base. Pain is often severe, and 
lymphatic involvement occurs earlier than in the more super- 
ficial variety first described, but it is not so precocious as in 
the other forms of carcinoma. 

Carcinomatous ulcers also result from the breaking-down 
of deep-seated carcinomata. They vary with the structure 
of the tumor and may be fungating or excavated. They are 
always attended by pain, involvement of the neighboring 
lymphatic glands, foul discharge, and cachexia. 

Putrefaction in a carcinomatous ulcer is due to the same 
causes as putrefaction elsewhere, i. e., the presence of 
saprophytes and dead organic matter. The malignant neo- 



PATHOLOGY. 203 

plasm outgrows its circulation, a portion necessarily dies, and 
this dead organic matter is attacked by the saprophytes. 
The heat, oxygen, and moisture which are always present, 
aid in the process. 

Name two culture media. 

Gelatin and agar-agar. 

What is a sanguinary or serumal calculus? 

A sanguinary or serumal calculus is a hard, dark calculus 
which may be deposited anywhere between the neck of the 
tooth and the apex of the root. As indicated by the name, 
it is derived from the blood instead of from the saliva. 

What are phleboliths? 

Literally, "vein-stones." The term is applied to concre- 
tions formed in the veins. They usually consist of dense, 
fibrous bodies, the result of calcification following a venous 
thrombus. 

What is exostosis? 

It is a circumscribed overgrowth of the cementum, ex- 
tending beyond the line of the fang of the tooth and giving 
an irregular outline to its' external surface. 

Give the etiology and clinical pathology of osteosarcoma. 

The etiology of sarcoma is as obscure as that of tumors in 
general. It occurs most frequently in young and middle- 
aged people particularly affecting the first and fourth de- 
cennial periods although it may be congenital. Trauma seems 
to be a more important factor in the development of sar- 
coma than in that of carcinoma. 

Osteosarcomata may be endosteal (central) or periosteal 
(peripheral). The endosteal growths may be myeloid (giant- 
celled) round-celled, or spindle-celled. The periosteal sarco- 
mata are either round or spindle-celled. 

The myeloid endosteal sarcomata are relatively benign, 
rarely giving rise to metastasis, and show a marked predilec- 



204 PATHOLOGY. 

tion for the inner side of the knee (the internal femoral con- 
dyle, the internal tibial tuberosity) the upper end of the 
humerus, and the lower end of the radius. 

The round or spindle-celled endosteal sarcomata are ex- 
tremely malignant. Although the growth may not expand 
the bone to any great extent, it extends throughout the medul- 
lary cavity and gives early metastases to the viscera or to the 
lymphatic glands. 

Either variety of endosteal growth may give " egg shell 
crackling " late in the 

The periosteal sarcomata grow very rapdly but do not 
give rise to great pain unless the bone be eroded. They 
commence at one side of the bone and soon spread about its 
entire circumference. These tumors frequently exhibit 
marked pulsation and a network of dilated veins may be 
seen through the overlying integument. The small round- 
celled periosteal sarcomata are the most malignant of all 
tumors, destroying life in from six to twelve months. 

State the degree of temperature most favorable to the 
development of pathogenic bacteria. 

The temperature of the human body. 

Give the etiology of rickets. 

In general any error of hygiene or diet. Insufficient or 
improper food, particularly the too early administration of 
starches. Prolonged nursing by the mother if she be un- 
healthy. Overcrowding, uncleanliness, and insufficient air 
and light. 

Give the predisposing and the exciting causes of neu- 
ralgia. 

Predisposing Causes. The hysterical temperament, anemia, 
depressing circumstances of all kinds such as mental anxiety 
and worry. 

Exciting Causes. Toxic, malaria, influenza, lead, mercury. 
Reflex, — ovarian disease, worms. Central, — disease of the 



PATHOLOGY. 205 

brain or spinal cord. Peripheral. — pressure upon the nerve 
roots, lesions of the nerve-trunks whether they be due to 
trauma, inflammation, or new growths. 

Give the predisposing and the exciting causes of tetanus. 
State the period of incubation of tetanus. 

Predisposing causes. The presence of a wound. Tropical 
climates. Occupation (stable attendants, agricultural la- 
borers). Race, (dark-skinned people, — Spanish, Italian, and 
negroes) . Defeat in battle. Bad hygiene, particularly the 
overcrowding of sick or wounded people in a limited space 
especially if antisepsis be impossible. 

Exciting cause. The introduction of the bacillus tetani. 

The period of incubation is exceedingly variable. It is 
usually stated to be from five to fifteen days although it may 
develop within a few hours or fail to make its appearance 
until a month has elapsed. 

Give the etiology of tubercular periostitis. 

Tubercular periostitis is immediately due to the deposit of 
tubercle bacilli in the deeper layer of the periosteum. The 
predisposing causes are those of inflammation in general. 

Name the different types of necrosis. 

Peripheral, central, and total. 

Describe the formation of tubercular abscesses. 

The first effect of tubercle bacilli upon the tissues is to 
stimulate the fixed connective tissue of the part, causing 
a proliferation of round cells which from their abundance oi 
protoplasm are known as epithelioid cells. There next oc- 
curs an infiltration with leucocytes from the surrounding 
blood-vessels. Giant cells have been said to result from the 
fusion of epithelioid cells but it seems more likely that they 
are due to the rapid multiplication of nuclei of these cells. 
The giant-cells are found in the center, then come the epithe- 
lioid cells, and finally abundant round-cells in the peripheral 
portion of the tubercle. The surrounding tissues usually shows 



206 PATHOLOGY. 

a tendency ito encapsulate the tubercle by the ordinary in- 
flammatory reaction similar to that produced by any irritant. 
In young tubercles of tubercular origin, the specific bacilli 
may be demonstrated in the epithelioid or subsequently in the 
giant-cells. In older tubercles the bacilli are rarely demon- 
strable although injection experiments show that spores must 
be present. As a result of the avascularity of the tubercle, 
together with the specific action of the living tubercle-bacil- 
lus, caseation takes place. True pus never results from the 
tubercle bacillus alone but is always due to mixed infection. 
The inflammatory reaction of the surrounding tissues i-esults 
in the formation an abscess-wall which consists of an outer 
fibrocicatricial layer and of an inner layer of yellowish-gray 
or pinkish granulation tissue containing miliary tubercles or 
even undergoing caseation. 



PATHOLOGY AND THERAPEUTICS. 



What changes occur in inflammation? 

Primarily. — A marked increase in the velocity of the blood- 
current and a dilatation of the vessels (arteries and capil- 
laries), caused by a stimulation of the vaso-dilator, or a 
paralysis of the vaso-constriotor, nerves, followed by a de- 
crease in the velocity of the blood and increased pressure 
with heightened temperature and redness. Leucocytes col- 
lect along the walls of the vessels and migrate through them 
by a process called diapedesis. Exudates pour into the inter- 
cellular spaces and the part becomes swollen, causing pain by 
pressure upon the nerve filaments. If resolution occurs, the 
inflammatory effusions will be taken up by the lymphatics 
and the part restored to health. If, on the other hand, sup- 
puration occurs, death of the part, or necrosis, may follow. 

What is septicemia and what causes it? 

It is a condition in which septic matter gains access to the 
circulating fluids of the body, caused by .the absorption of the 
toxins produced by bacteria. 

How do you treat putrescent pulps? 

The contents of the pulp cavity and canals should be steril- 
ized with a ten per cent, solution of formalin, after which 
the pulp should be removed with sterilized broaches, great 
care being exercised not to force any of the canal contents 
into the apical space. Canals should then be thoroughly 
cleansed with sodium dioxide, followed by an application of 
dilute sulphuric acid. Neutralize the acid with a bicarbonate 
.of soda solution, dry with absolute alcohol, and fill canals 
with antiseptics on cotton, or fill permanently as indicated. 

(207) 



208 PATHOLOGY AND THERAPEUTICS. 

What symptoms indicate diseases of the dental pulp? 

Paroxysms of pain upon application of thermal test, in- 
creased pain upon assuming a recumbent position, neuralgic 
pain along the course of the fifth nerve. 

Why is a pulp capped? When? How? 

To preserve its vitality. In young patients when the pulp 
has been exposed by accident in excavating. Make a concave 
disc of gold, platinum, tin or copper, large enough to com- 
pletely cover the exposure ; fill the disc with a paste made 
from zinc oxide and one of the essential oils, place this over 
the exposure and seal over with zinc oxysulphate. Cover the 
whole with a temporary filling. If pulp continues vital and 
normal for three or six months, it is reasonably safe to insert 
a permanent filling. 

Which tissue of the tooth dies with the pulp, and which 
remains alive? 

The dentine dies with the pulp, and the cementum remains 
alive. 

What are parasitic bacteria, and how do they cause 
disease? 

Parasitic bacteria are those forms which subsist upon living 
animal tissue, producing toxins, which, when taken into the 
circulation, cause disease. 

How does mercuric chloride act as an antiseptic? 

Mercuric chloride acts as an antiseptic by destroying bac- 
teria. The mercury in the compound when brought into con- 
tact with albuminous substances, combines with the albumin, 
thereby destroying its identity, as well as its vitality. 

What are some of the manifestations of pathological 
dentition? 

In deciduous pathological dentition, we may have gastro- 
intestinal disturbances, marked stomatitis and, in severe cases, 
convulsions may occur. In permanent dentition, some of the 



PATHOLOGY AND THERAPEUTICS. 209 

pathological conditions most frequently met with are impac- 
tion or eruption in malposition of third molars, impaction of 
lateral incisors, supernumerary teeth, fusion, irregularities as 
to the number of cusps, odontoceles and dentigerous cysts. 

What are the principles of treatment in dental caries? 

The employment of an alkaline solution to neutralize acids 
present, removal of carious tissue, the destruction of micro- 
organisms by the use of germicides, and the hermetical seal- 
ing of the cavity by means of filling materials. 

What is the danger of chronic septic pericementitis, and 
what is the treatment? 

The danger is the opening of the pus cavity upon the face, 
or the infiltration of pus into the tissues surrounding the 
tooth, causing necrosis of the pericemental membrane and loss 
of tooth. The treatment consists of the mechanical removal 
by warm water of pus masses and the antiseptic treatment of 
the affected part, after which mild stimulation should be em- 
ployed to hasten formation of granulation tissue. 

Name four agents used in acute diseases of the pulp and 
give the physiological action of each. 

Tr. Aconite administered in one-drop doses reduces the 
force of the circulation and acts as a sedative to the nervous 
system. 

Carbolic acid, being antiseptic and sedative in its action, 
may be used in cases of hyperemia of the pulp. A saturated 
solution of menthol in chloroform, if placed in a cavity of a 
tooth exhibiting symptoms of pulpitis (acute), has an anes- 
thetic and antiseptic effect. 

A paste of cocaine and glycerine may also be used in cases 
of pulpitis, which acts as an analgesic. 

What causes an alveolar abscess? 

Access of septic matter to the apical space, or direct bac- 
terial invasion of that area during an attack of apical peri- 
cementitis. 
14 



210 PATHOLOGY AND THERAPEUTICS. 

What is phagedenic pericementitis? 

A disease of the pericemental membrane producing necro- 
sis of that organ. In this particular condition, calcareous 
deposits may be present, and gingivitis may not be marked. 

How do you diagnose exostosis? 

Exostosis is accompanied by the presence of vaguely re- 
flected pains, it being usually impossible to locate the seat 
of the trouble ; the X-ray, however, demonstrates the condi- 
tion very efficiently. 

What causes induce periodontitis? 

Traumatism and septic infection. 

What dangers are to be apprehended from abscess upon 
the temporary teeth? 

Pus gaining access to the follicle of the permanent succes- 
sor, interfering with its development. Non-resorption of the 
deciduous root causing mal-eruption of permanent tooth. 
Possible necessity for premature extraction of the temporary 
tooth, resulting in impaction or mal-eruption of permanent 
tooth. 

What results are likely to follow abrasion of the teeth? 

Heightened sensitivity of the dentine, and deposits of sec- 
ondary dentine in the pulp cavity. 

What causes superinduce the devitalization of non- 
carious teeth? 

Traumatism, causing severe hyperemia and death of tbe 
pulp by strangulation. This includes too rapid wedging, as 
well as too rapid movement in regulating cases. 

How would you conduct a thermal test to locate an in- 
flamed pulp? 

By isolating each tooth with rubber dam and projecting 
against it, alternately, jets of cold and hot water, until the 
offending member has been located by an exaggerated re- 
sponse to the test. 



PATHOLOGY AND THERAPEUTICS. 211 

Give some causes of necrosis. 

Thrombus in a terminal artery ; or, ligation of a vessel 
cutting off the supply of nutrition to the part. 

Which of the permanent teeth are most liable to patho- 
logical eruption, and why? 

The upper and lower third molars. The former frequently 
erupt with their occlusal faces directed toward the cheek 
owing to an insufficient space between the second molars and 
the pterygoid processes for their accommodation normally 
within the arch. The lower third molars are more frequently 
retarded in their eruption, also due to lack of space. 

Describe epulis within tooth cavity. Describe fungoid 
pulp. 

Epulis within a tooth cavity is a pedunculated fibrous 
growth gaining access to the cavity usually through an open- 
ing at the bifurcation of the roots of molar teeth. This 
opening is caused by caries. The condition resembles very 
closely "iingoid pulp, a hypertrophic condition of the pulp 
which is fibrous in character and highly vascular. 

In what abnormal condition will resorption of the tem- 
porary teeth cease? 

In temporary teeth containing putrescent pulps, or a peri- 
cemental membrane in a suppurating condition, resorption 
may not occur. 

Describe and give the supposed cause for Hutchinson's 
teeth. 

Hutchinson's teeth present a notched appearance upon the 
cutting edges, the longitudinal axis of these edges being short- 
ened. The supposed cause is congenital syphilis. 

How is pulp irritation from loss of tooth substance dis- 
tinguished from sensitive dentine? 

If exaggerated pain is experienced from contact with in- 
struments upon the abraded surface, the condition is that of 



212 PATHOLOGY AND THERAPEUTICS. 

hypersensitive dentine. If this contact causes but a mild 
response and the thermal test produces marked paroxysms of 
pain, the condition may be diagnosed as irritation of the pulp. 

What results may follow the premature extraction of 
the temporary molars? 

The first permanent molar may tip forward and occupy 
the space which the second bicuspid should take upon erup- 
tion, thereby causing either mal-eruption or impaction of the 
bicuspid tooth. 

How would you differentiate between pericementitis and 
alveolar abscess? 

In pericementitis, the pericemental membrane becomes 
thickened, the tooth elongated and extremely sensitive to per- 
cussion. A reddening of the gum tissue is noted over the 
affected tooth. In alveolar abscess we have an exaggerated 
likeness to these symptoms together with swelling over the 
affected tooth, intense pain with a subsequent discharge of 
pus. 

Name some of the pathological conditions of the dental 
pulp. 

Passive and active hyperaemia, pulpitis, pulp nodules, dry 
and moist, gangrene, and pulp hypertrophy. 

Give the cause of dental exostosis and describe the 
symptoms. 

The cause of dental exostosis may be extraction of the 
occluding tooth : the pericementum not being met by the ac- 
customed resistance, proliferates cementum upon the apex 
of the root. Or, traumatic injury, causing continued mild 
irritation of the pericementum, may give rise to a like condi- 
tion. The symptoms are vague pains about the affected tooth, 
sometimes assuming a reflected neuralgic type. 

How would you diagnose and locate an inflamed pulp 
where no cavity exists? 

By the thermal test. 



PATHOLOGY AND THERAPEUTICS. 213 

What are bacteria? 

Bacteria are minute organisms representing the lowest or- 
der of plant life. 

Give the symptoms of septicemia. 

The general symptoms of septicemia are fever and chills, 
diarrhoea, rapid and weak pulse and clammy condition of the 
skin. If the infection has been from a wound, the discharge 
coming from it will be putrid. 

What conditions are necessary for the growth and de- 
velopment of bacteria? 

Proper food-supply, removal of waste products, moisture, 
proper temperature and the presence of free oxygen. This 
last-named condition, however, is not necessary for the exist- 
ence of the anaerobic bacteria. 

Give Miller's theory of dental caries. 

The presence of sugar in the mouth causes fermentation and 
the production of lactic acid which dissolves out the lime con- 
stituents of the teeth. Micro-organisms gaiin access to the 
dentinal tubuli and proliferate ; they follow in the wake of 
the decalcifying process and subsist upon the organic tooth 
substance, producing acids. 

By and under what conditions is pus produced? 

Pus is produced by the invasion of the staphylococcus 
pyogenes aureus, citreus or albus, or by streptococcus pyo- 
genes, the gonococcus, the bacillus pneumonae or other pyo- 
genic organisms into an area susceptible to inflammatory 
changes, or already inflamed. The white blood corpuscles to- 
gether with other wandering cells of the body, are devital- 
ized by the bacteria and become pus corpuscles. 

What are leucocytes and what are their functions? 

Leucocytes are the white blood corpuscles. They exercise 
phagocytic activity, devouring and carrying away invading 
bacteria and other irritating organic substances which gain 
access to the tissues. 



214 PATHOLOGY AND THERAPEUTICS. 

Name some of the pathogenic fungi found in the mouth. 

Micrococcus of sputum septicemia. 
Bacillus salivarius septicus. 
Micrococcus gingivae pyogenes. 
Saccharomyces albicans. 
Pneumo-bacillus. 

What is meant by lactic fermentation and why is it of 
extreme interest to dentists? 

Lactic fermentation is that process or change which occurs 
in solutions of the fermentable carbohydrates, producing 
lactic acid. This product is of interest to dentists, as it is 
the prime factor in the production of dental caries. 

What effects may be produced in the mouth from the 
administration of large doses of calomel? Describe the 
condition. 

Large doses of calomel produce a condition known as mer- 
curial stomatitis. The gums around the necks of the teeth 
become inflamed and swollen, ulceration of the mucous mem- 
brane occurs, the teeth become loosened, and there is a marked 
increase in the flow of saliva. The breath is fetid, and there is 
an unpleasant metallic taste in the mouth. The severity of 
these symptoms depends upon the susceptibility of the patient, 
as, in some cases, loss of the teeth occurs, and even necrosis 
of the maxillary bones. 

Differentiate between hyperaemia, inflammation and 
suppuration. 

Hyperaemia is an excess of blood in a part. Inflammation 
is the succession of changes (hyperaemia being one of these 
changes) which occur in a tissue during its effort to rid itself 
of an irritant, provided the irritant is not of sufficient strength 
to cause immediate death of the part. If, in the last stages of 
inflammation, resolution does not occur, and pyogenic or- 
ganisms invade the inflamed area, suppuration, or the forma- 
tion of pus, will occur. 



PATHOLOGY AND THERAPEUTICS. 215 

What is the source of nourishment of bacteria? How 
do they obtain oxygen? 

Bacteria contain no chlorophyl, and, therefore, have not the 
power to decompose water and carbon dioxide to effect the 
synthesis of starch. Hence, they are compelled to derive their 
nourishment from organic compounds. According to their 
method of obtaining oxygen, bacteria are divided into three 
classes; aerobic, those depending upon the presence of free 
oxygen, anaerobic, those not requiring free oxygen, as they 
possess the power to appropriate the oxygen from unstable 
organic compounds ; and facultative, or those which flourish 
in either condition. 

What is salivary calculus, where is it found, and what 
effect has it? 

Salivary calculus is a deposition of the salts of lime (car- 
bonate and phosphate), held in solution in the saliva, upon the 
surfaces of the teeth, usually near the gum margin, in proxi- 
mal spaces and deep sulci. Carbon dioxide plays an active 
part in the precipitation of the calculus. Large deposits 
are frequently found near Steno's duct, the opening of the 
parotid gland, and on the lingual and labial surfaces of the 
lower interior teeth. Deposits of tartar have the effect of 
producing recession of the gum, causing sufficient irritation 
at times to produce inflammation and even suppuration. If 
allowed to continue, the deposits may be responsible for affec- 
tions of the pericemental membrane and alveolar process, and 
also tooth loss. 

What is the difference between an antiseptic and a 
germicide, and give examples? 

Antiseptics prevent the action of pathogenic organisms and 
their products on the living body, but do not necessarily kill 
the micro-organisms. Germicides destroy the vitality of the 
germs of disease. Germicides are antiseptics, though anti- 
septics are not necessasrily germicides. Iodoform is an anti- 
septic ; mercuric chloride is a germicide. 



216 PATHOLOGY AND THERAPEUTICS. 

What is pyrozone? How does it act, and for what is 
it used? 

Pyrozone is a solution of hydrogen dioxide in water or 
ether. A 3% aqueous solution acts as an antiseptic and dis- 
infectant; these properties are due to the setting free of 
oxygen when the solution is brought in contact with organic 
matter. In this strength, it is valuable in cases of ulcerative 
stomatitis, and also in softening deposits of calculus. For 
cleansing pus pockets, it is an effective agent. A 25% 
ethereal solution is used as a bleaching agent, caustic and 
styptic. 

How are the diseases of the pericementum diagnosed 
from those of the pulp? 

Diseases of the pericementum respond freely in paroxysms 
of pain to any presssure brought to bear upon the tooth, while 
the pulp disorders are demonstrated by the thermal test. 
Pericemental disorders can always be located by the patient. 
Pains from pulp affections are more often reflected. When 
one is complicated by the presence of the other both symp- 
toms may be in evidence. 

At what age is the first permanent tooth erupted, and 
which tooth is it? 

The first permanent tooth is erupted at about the sixth 
year ; it is called the first molar, or sixth year molar. 

How do you treat hypersensitive dentine? 

In the treatment of hypersensitive dentine the rubber dam 
should be applied if possible and absolute dryness secured. 
This, in itself, ofttimes produces sufficient anaesthesia to per- 
mit instrumentation. In obstinate cases, however, it may 
be necessary to employ other therapeutic measures. If the 
cavity be not deep, a solution of caustic soda (ten grains to 
the ounce of water) is sometimes effective. A paste of cocaine 
muriate and glycerine, sealed in the cavity for 24 hours, may 
be used with good results. Cocaine may also be employed 



PATHOLOGY AND THERAPEUTICS. 217 

by cataphoresis. Carbolic acid, chloroform, ethyl or methyl 
chloride (in spray) are also indicated. In cases of hyper- 
sensitivity of abraded teeth (where no cavity exists), the tooth 
or teeth should be isolated by the rubber dam and strong 
mineral acids, such as nitric, sulphuric and hydrochloric 
applied. These agents coagulate the contents of the tubules. 
The surfaces, treated in this manner, should always be ex- 
cavated and filled. 

What dangers must be guarded against in the use of 
arsenic for devitalizing the pulp of a tooth? 

Arsenic, for the purpose of devitalizing the pulp, should 
be employed with great care. If possible the tooth should be 
isolated with rubber dam. If carelessly applied, a minute 
portion of arsenic may come in contact with the gum tissue 
or be insinuated in the gingival space, producing sloughing 
of the peridental membrane and gum tissue, or necrosis of 
the process, or both. Great care should be exercised in seal- 
ing arsenic in a cavity to prepare the margins of the cavity 
in such a way as to permit hermetical sealing. Pastes of 
arsenic should be applied without an excess of fluid, as there 
is danger of oozing about the margins during the process of 
sealing. This drug should never be used for the devitaliza- 
tion of pulps in deciduous teeth. 

Give the differential diagnosis between hyperaemia, in- 
flammation and suppuration of the pulp. 

In hyperaemia the pulp responds to the application of heat 
or cold in a somewhat exaggerated degree, owing to the 
dilatation of the vessels. Cases of hyperemia usually give a 
history of mild attacks of odontalgia, transient in character. 
In inflammation of the pulp the response to cold is somewhat 
diminished; the application of heat produces pain of a severe 
type. Odontalgia becomes constant, throbbing in character, 
increasing when the patient assumes a recumbent position. 
Neuralgic pains may be felt along the course of the fifth nerve. 
Suppuration begins in the late stage of inflammation, and is 



218 PATHOLOGY AND THERAPEUTICS. 

indicated by a cessation of response to cold applications. 
Heat produces agonizing paroxysms of pain, only alleviated by 
the immediate application of cold. The pain now assumes 
a gnawing character, persistently increasing, while throbbing 
ceases. 

What are saprophytic bacteria, and how do they cause 
disease? 

Saprophytic bacteria are those forms which nourish upon 
dead organic substances, effecting their decomposition, and 
producing poisons, through the agency of which they become 
causes of disease. 

What objections are there to the premature extraction 
of the temporary teeth? 

Premature extraction of the temporary teeth is followed by 
insufficient space for the normal eruption of their permanent 
successors, resulting in malposed permanent teeth, and, not 
infrequently, their impaction. 

How do you distinguish erosion of the teeth and caries? 

Erosion is characterized by cupped-out cavities with hard, 
glossy surfaces usually on the labial aspects of teeth, while 
earies presents a softening of the tooth structure. Caries 
may follow erosion. 

How is the destruction of tissue brought about in dental 
caries? 

The product of lactic fermentation (lactic acid) decalcifies 
the tooth at a vulnerable point, and the micro-organisms of 
the mouth attack and destroy the organic remains. 

What is resorption of the roots of deciduous teeth? Is 
it a physiological or pathological condition? 

Resorption of the roots of deciduous teeth is a physiological 
process brought about by the phagocytic action of multi- 
nucleated cells, these cells secrete a ferment, which liquefies 
the roots, and in this condition they are taken up by the lym- 



PATHOLOGY AND THERAPEUTICS. 219 

phatics. In short it is nature's method of preparing a path 
for the eruption of the permanent successors. 

Describe the pathologic changes which occur in the 
dental pulp starting from irritation and ending in pus for- 
mation. 

Pulp irritation may result from traumatism, excessive 
thermal stimuli, drug action, or infection. Active hyper- 
aemia of the pulp occurs with a marked dilatation of 
the arteries and arterial capillaries. If the cause of 
the irritation is not removed, the white blood-cells in these 
vessels collect along the walls in great numbers, thereby im- 
peding the flow of the blood stream. If dilatation occurs in 
the arteries near the apex of the tooth, the return flow of the 
blood is cut off by an impingement of the engorged arteries 
upon the apical veins. Diapedesis now occurs and the white 
blood-cells, together with effusions of inflammation, are poured 
out into interstitial spaces. This phenomenon marks the on- 
set of pulpitis. If the pulp be infected by pyogenic organ- 
isms, the leucocytes are overpowered and die, becoming pus 
corpuscles. 

Why should deciduous teeth receive early and system- 
atic treatment? 

Deciduous teeth should receive systematic treatment, be- 
cause their retention in the arch until the time of eruption 
of their permanent successors, has much to do with the 
normal eruption of these latter. 

What effect may be produced on the dental pulp by con- 
tinued mild irritation? 

Continued mild irritation may excite the functional activity 
of the odontoblasts, thereby producing secondary dentine at 
the expense of the volume of the pulp and its chamber. 

Give the differential diagnosis between pulpitis and peri- 
cementitis. 

Pulpitis is characterized by throbbing pain of a severe 



220 PATHOLOGY AND THERAPEUTICS. 

type, aggravated in its early stages by contact with hot or cold 
substances. The pain is of a reflected type, due to the fact 
that the pulp has no tactile sense. But very mild response 
is elicited from percussion. In pericementitis, the tooth is 
somewhat elongated by a thickening of the inflamed apical 
pericementum, and responds exquisitely upon percussion. 

Describe the treatment for restoring a sound, superior, 
central incisor tooth displaced from its socket by violence. 

The tooth should be placed in a solution of bichloride of 
mercury (1 to 1000) for some minutes, after which the pulp 
cavity should be cleansed and filled. Replace the tooth in 
bichloride solution. Now thoroughly cleanse the tooth socket 
with jets of warm water, removing all clot, and sterilize with 
stimulating antiseptics such as campho-phenique, etc. Great 
care must be observed to keep the mouth in an aseptic condi- 
tion, both during and for a considerable period after the 
operation. The tooth should be removed with sterile forceps 
from the solution, and thrust back into its socket without 
handling. Immobilization may be accomplished by a cap of 
gold securing it to its fellows, and this allowed to remain until 
the tooth has become thoroughly fixed. 



THERAPEUTICS AND MATERIA 
MEDICA. 



What is meant by idiosyncracy? 

A peculiar or abnormal response to the action of a drug. 

For what conditions in the mouth is sulphuric acid use- 
ful? In what strength and in what manner may it be 
employed? 

In hypersensitive dentine, in simple cavities of decay, to 
open and enlarge minute root-canals. In these cases it is em- 
ployed in 50% strength, applied with a gold probe and neu- 
tralized with so 'ium bicarbonate. In about 10% solutions, 
it may be employed to remove dead bone. 

In what manner may the teeth be best protected from 
the effects of acids administered internally through the 
mouth? 

Acids should be well diluted, taken through a tube, and an 
antacid at once used to counteract any acidity induced 
through their use. 

What is a counter-irritant? Name two used in the 
mouth. 

A counter-irritant is an agent used to excite vascularity 
where applied, resulting in the relief of pain and vascularity 
in other parts, e. g. capsicum and tincture of iodine. 

What is the dose of tincture of aconite root? 

One half to five minims. 

What is the local action of aconite? 

It acts as a powerful sedative, causing tingling and numb- 

(221) 



222 THERAPEUTICS AND MATERIA MEDICA. 

ness, due to paralysis of terminal nerve filaments. Slightly 
irritating at first. 

What preparation of arsenic is most used in dentistry, 
and what is the local action of this preparation? 

Arsenic trioxid. 

When brought in contact with the tooth pulp we have con- 
gestion, accompanied by grumbling pain which in a few 
hours becomes acute and throbbing. The blood-vessels be- 
come strangulated at the apex of the root, resulting in the 
death of the pulp, with cessation of pain. 

What preparation of iron is particularly injurious to 
the teeth? Why is it injurious? 

Tincture chloride of iron. On account of the free hydro- 
chloric acid it contains. 

Name the drugs that may be combined with arsenic 
for devitalizing a tooth pulp, and state what purposes 
these drugs serve. 

Combined with acetate or sulphate of morphine or hydro- 
chlorate of cocaine, as local anodynes, with an essential oil 
to make a paste and facilitate the application as well as action. 

Name three local anesthetics used in dentistry, and 
state the conditions that call for their application. 

Cocaine hydrochlorate, carbolic acid, tincture of aconite. 
Cocaine hydrochlorate, for hypodermic use in extraction. 
Carbolic acid, where the sensibility of the gum is to be de- 
stroyed to permit of painlesss incision being made. Tincture 
of aconite, to allay pain by its application to the gum 
tissue in cases of pericementitis. 

What desirable qualities should a disinfectant possess 
for use in a pulp canal? 

Ability to neutralize various products resulting from 
putrefactive processes, and the attribute of penetrability. 



THERAPEUTICS AND MATERIA MEDIC A. 223 

What conditions about the mouth call for the use of 
iodine, and what are its effects? 

In pericementitis, oedema of cheeks or lips, as an aid in 
removing green stain from the surfaces of teeth. Acts as a 
counter-irritant and stimulates absorption of effusions. 

What conditions about the mouth call for the use of 
carbolic acid, and what are its effects? 

Full strength acts as a caustic and may be used to touch 
ulcers. In a 1% or 2% solution, as an antiseptic mouth- 
wash in stomatitis. 

How should any injurious results arising from the local 
action of arsenic on the gums be treated? 

By removing all necrotic tissue and touching with an iron 
preparation or tincture of iodine. 

Name two preparations of opium. State the dose of each. 

Tincture of opium or laudanum. Dose, 5 to 15 minims. 
Camphorated tincture of opium or paregoric. Dose, 1 to 
4 fluiddrachms. 

Of what drugs are morphine and atropine the alkaloids? 

Opium and belladonna respectively. 

Name a physiologic antidote to cocaine. 

Morphine, whisky, or nitrite of amyl. 

For what is permanganate of potassium used in 
dentistry? 

Ulcer of the mouth with offensive breath, abscesses, diseases 
of the antrum, necrosis and caries of bone. 

What are the dental uses of the essential oils? 

To obtund hypersensitive dentin, to allay pain in an irri- 
tated pulp, to promote antisepsis in septic root-canals and 
cavities. 



224 THERAPEUTICS AND MATERIA MED1CA. 

Describe the effect of aconite on the heart and name 
two other drugs which have a similar effect. 

Small doses decrease the force of ventricular contraction 
and slow the action of the heart. Large doses cause rapid 
weak action with tendency to stop in diastole. 

Veratrum viride and antimony have a similar effect. 

For what is amyl nitrite used, and how is it admin- 
istered, and what is the dose? 

Stimulant, particularly in cocaine poisoning. Usually ad- 
ministered by inhalation in three to five minim doses. 

What is the danger of using acids in the mouth? What 
precaution should be taken? 

They may cause decalcification of tooth structure. They 
should be followed by antacid washes. 

For what is hydrogen peroxide used? 

To destroy pus, cleanse putrescent pulp-canals, and when- 
ever a germicide, deodorant or disinfectant is required in 
the mouth. 

Name two escharotics, and state when escharotics should 
be used. 

Silver nitrate, carbolic acid. Escharotics are employed for 
the removal of hypertrophied gum tissue. To obtund hyper- 
sensitive dentin. In the treatment of ulcerative stomatitis, 
and to destroy pulp filaments in roots. 

What precautions should be observed in the adminis- 
tration of the general anesthetics? 

Patients should not eat anything for several hours previous, 
should have bowels thoroughly evacuated, should be placed 
in a horizontal position, all foreign substances removed from 
the mouth, clothing loose around the neck and chest, a third 
party present if the patient be a female, and the anesthetic 
selected with reference to any organic disease of the patient. 
Development of dangerous symptoms should be watched for, 



THERAPEUTICS AND MATERIA MED1CA. 225 

and the anesthetic should not be given in an overdose. Re- 
suscitating means should be at hand. 

Define hemostatic. Give three examples. 

Hemostatics are agents which stop hemorrhage by coagu- 
lating albumin and contracting the muscle fibres, e. g., tannic 
acid, tincture of iron, and adrenalin chloride. 

Mention a medicine whose local action contracts the 
blood vessels of a part. 

Adrenalin chloride. 

Mention a medicine whose local action dilates the blood 
vessels of the part. 

Aconite. 

Differentiate disinfectant from antiseptic. Give illus= 
trations of each. 

Disinfectants are agents which destroy the germs of dis- 
ease. Antiseptics inhibit the growth of micro-organisms and 
neutralize the toxins, but do not necessarily kill the germs. 

Permanganate of potassium (2% solution), bichloride of 
mercury (1-1000), peroxide of hydrogen are disinfectants. 

Boric acid and the essential oils in mild solution act as 
antiseptics. 

What is the objection to the use of iodoform? Men= 
tion three drugs that may be used in place of iodoform. 

Its very objectionable odor. Iodol, aristol and europhen 
may be used in place of iodoform. 

What is the advantage of the cataphoric as compared 
with the ordinary local application? 

The deeper layers of the dentin and the piilp itself may 
be affected, whereas the ordinary application could not be 
made to affect these. 

What two medicines are particularly useful in cata= 
phoric applications? 

Cocaine hydrochlorate to desensitize dentin and pulp, and 
25% pyrozone for bleaching. 
15 



226 THERAPEUTICS AND MATERIA MEDIC A. 

Mention (a) three remedies for toothache caused by ex- 
posure of the pulp; (b) two remedies for pericementitis. 

(a) Oil of cloves, oil of cinnamon, carbolic acid. (b) 
Tincture of aconite and tincture of iodine. 

Mention(a)a remedy that antagonizes the constitutional 
action of aconite; (b) a remedy that increases the constitu= 
tional action of aconite. 

(a) Opium, (b) Veratrum viride. 

Mention the dose of two of the preparations of opium, 
and the dose of one of the alkaloids of opium. 

Tincture of opium, 5 to 20 minims ; powdered opium, l / 2 to 
2 grains; sulphate of morphine, y s to y 2 grain. 

Mention the dose of (a) potassium bromide, (b) chloral, 
(c) acetanilid. 

(a) Potassium bromide, 10 to 60 grains; (b) chloral hy- 
drate, 5 to 20 grains; (c) acetanilid, 2 to 10 grains. 

Mention two heart stimulants that act rapidly, and give 
the dose of each. 

Aromatic spirits of ammonia, 30 to 60 minims. 
Ether, 10 to 60 minims. 

State the action of digitalis on (a) the heart, (b) the 
blood vessels, (c) the kidneys. 

(a) Increases the force of the heart contractions; lengthens 
diastole, decreasing the number of beats by stimulation of the 
pneumogastric. 

(b) Raises arterial tension by stimulating vasomotor cen- 
ter, by direct action on the muscular coat and by increasing 
the force of the heart's contraction. 

(c) Dilatation of the renal arteries resulting in an in- 
creased flow of urine, without an irritating effect on the 
renal epithelium. 



THERAPEUTICS AND MATERIA MEDIC A. 227 

What drug is often combined with morphia when given 
hypodermically? Explain. 

Sulphate of atropine. Atropine being the physiological 
antagonist, it diminishes the danger of morphia-poisoning. 

Which of the general anesthetics is most depressing to 
(a) the circulation, (b) the respiration? 

Chloroform to the circulation, and ether to the respiration. 
Mention two medicines that increase blood pressure. 

Digitalis and strophanthus. 

Distinguish between a stimulant and an irritant. 

A stimulant produces increased functional activity. An 
irritant exceeds the effect of a stimulant and induces venous 
hyperemia, and possibly inflammation. A stimulant acting 
continuously may become an irritant. 

With what class of remedies are the coaUtar products 
prescribed for action on the heart? 

With cardiac stimulants. 

What are the dental uses of the alkalies? Mention 
three alkalies. 

To counteract any acid condition in the mouth, as in ero- 
sion or after acid medicaments. Lime, magnesium, sodium 
bicarbonate. 

What effect on blood pressure has (a) ether, (b) 
chloroform? 

Ether increases blood pressure. Chloroform lowers blood 
pressure. 

State the dental uses of nitrate of silver. 

In the form of lunar caustic it may be used to destroy 
ulcers in the mouth, or to destroy hypersensitiveness of the 
dentin ; in a 5% or even 10% solution, it is employed in 
gangrenous stomatitis. In 50% solutions it has been recom- 
mended in the treatment of root-canals. 



228 THERAPEUTICS AND MATERIA MEDICA. 

State, with reference to formaldehyde, (a) its dental 
uses, (b) the advantages of its use, (c) the objections to 
its use. 

In mild solutions, in association with other agents, as an 
antiseptic mouth-wash : in strong solutions, about 5 to 10', 
of formalin, it is used to disinfect instruments. In the treat- 
ment of moist gangrene of the pulp, and wherever a powerful 
disinfectant is indicated without regard to its intensely irri- 
tating effect upon mucous surfaces. It is a powerful disin- 
fectant, and has a hardening effect upon disintegrated organic 
matter. It is intensely irritating to mucous surfaces. 

State the conditions under which it is more advantageous 
to give medicines hypodermically than to administer 
them internally. 

When you wish to produce an immediate effect. When the 
patient cannot swallow, or is in a condition where absorption 
from the stomach would take place slowly. 

Mention one drug that contracts the pupil of the eye; 
one drug that dilates the pupil of the eye. 
Eserine contracts: belladonna dilates. 

State the reasons for or against the use of arsenious 
acid to obtund sensitive dentin. 

It should not be used to obtund hypersensitive dentin, as 
it will devitalize the pulp. 

Of what is each of the following an alkaloid (a) strych = 
nine, (b) atropine, (c) morphine. State the dose of each. 

(a) Xux vomica, (b) belladonna, (c) opium. 
Strychnine, ^ to -£$ gr. ; atropine, y^ T to T ^ gr. ; morphine 
| to I gr. 

What property of tincture of iodine makes it of value in 
pericementitis? 

Its counter-irritating property, and its ability to stimulate 
the lymphatics to absorb inflammatory products. 



THERAPEUTICS AND MATERIA MEDICA. 229 

In what position should the patient be during the ad- 
ministration of chloroform? Why? 

In the recumbent position, to allow of the easy flow of 
blood to the heart, to counteract the paralyzing influences 
of chloroform upon the circulation. 

Name four properties that a dentifrice should possess. 

Alkaline, antiseptic, sufficiently coarse to be cleansing, and 
agreeable flavor. 

What is an antiphlogistic? 

Any therapeutic means of combating the heat of inflam- 
matory reactions. 

What is an escharotic? 

An agent which devitalizes the tissue upon which it acts, 
producing an eschar or slough. 

Define narcotics and sedatives and give an example of 
each. 

Narcotics are agents that stimulate and stupefy the brain, 
allay pain and induce sleep, as opium. Sedatives are agents 
that depress the nervous centers and allay their irritability 
or excitability, as bromide of potassium. 

Describe what is meant by an aqueous solution, and 
write a prescription, giving example. 

An aqueous solution is a drug held in solution with water. 

B . Acidi tannici gr. x 

Aquae f^j 

Sig. — Use as directed. 

What is arsenous acid? Give medical properties and 
special dental use and antidote. 

Trioxide of arsenic. Internally, in small doses, it acts as an 
alterative tonic, promoting appetite and digestion, stimulating 
respiration and circulation, and increasing mental faculties. 
In dentistry, it is employed to devitalize the pulp. The anti- 



230 THERAPEUTICS AND MATERIA MEDIC A. 

dote in cases of poisoning is freshly prepared hydrated ferric 
oxide. 

Give the medical properties and dose; when indicated in 
dental practice, and how used; toxic effects, if any; anti= 
dotal treatment of each of the following: — Aconite, 
quinine, napthol, creasote, oil of cloves. 

Aconite locally paralyzes the terminal sensory filaments, 
causing numbness and loss of sensibility. Internally, in small 
doses it depresses respiration and circulation, and in large 
doses it paralyzes the heart's action. In dental practice it 
may be used locally to stop pain from an irritated pulp, or 
as a sedative applied over the gum in pericementitis. Opium, 
or any cardiac stimulant, together with artificial respiration, 
is used in cases of poisoning. The dose is 1 to 3 minims of 
the tincture. 

Quinine is a tonic, antiseptic, antipyretic and antiperiodic. 
It interferes with the function of the red blood-corpuscles 
and arrests the movements of the white. In small doses it 
stimulates the brain; in large doses it produces cerebral ane- 
mia, ringing in the ears, headache, delirium and coma. The 
tonic dose is 2 grs., the antipyretic 5-10 grs., and the anti- 
periodic 10-20 grs. Morphine antagonizes its cerebral action, 
atropine its cardiac and antipyretic effects. Its use in den- 
tistry is indicated when a patient gives evidence of septic 
fever through absorption of septic products in cases of acute 
septic pericementitis or alveolar abscess; in combination with 
acetanilid and salol, two grains of the sulphate of quinine 
given every two or three hours will have a controlling effect. 

Naphthol is a derivative of naphthalin, and has marked 
antiseptic properties. In dentistry it is used as hydronaph- 
thol, a powerful antiseptic in a 1 to 200 solution. 

Creasote locally acts as an anodyne. Internally in small 
doses, its action is similar to carbolic acid. It is eliminated 
by the bronchial mucous membrane, which it stimulates, pro- 
ducing the effects of an expectorant. It is sedative to the 
mucous membrane of the stomach. In dentistry, it is indi- 



THERAPEUTICS AND MATERIA MED1CA. 231 

cated wherever carbolic acid is used, although the latter is 
favored because it has not the intensely disagreeable odor of 
creasote. Dose, 1 to 3 minims in oil. 

Oil of cloves belongs to a group of aromatic oils that 
possess many properties in general. They are antiseptics, 
stimulants, and local anesthetics. Dose, 1 to 5 minims. In 
dentistry they are used generally to allay pain in an aching 
pulp. 

Name three drugs useful in the treatment of empyema 
of the antrum, and write a prescription containing one 
such drug in solution. 

Hydrogen dioxide, chloride of zinc, hydronaphthol. 

R. Hydronaphthol 3J 

Alcohol f 3 j 

Sig. — Teaspoonful in a wineglass of water. 

Name three heart stimulants administered hypodermi= 
cally in the order of their rapidity of action. State dose 
of each. 

Alcohol, strychnine, digitalis. 
Alcohol (whisky), 30 to 60 minims. 
Strychnia sulphate, -J^ to ■£$ gr. 
Digitalis (tincture), 5 to 10 minims. 

Define styptic and irritant, and give an example of each. 

A styptic is an agent applied locally to check hemorrhage, 
like tannic acid. An irritant is an agent capable of draw- 
ing an excess of blood to the part upon which it is acting, like 
iodine. 

Name two drugs that are physiologically incompatible, 
and two that are chemically incompatible- 

Aconite and morphine, belladonna and opium, are physio- 
logically incompatible. Tannic acid and iron, sulphuric acid 
and lime, are chemically incompatible. 

Give the dental uses of oil of cinnamon, silver nitrate, 
aconite, capsicum. 

Oil of cinnamon is used to allay pain in an irritated pulp. 



232 THERAPEUTICS AND MATERIA MEDIC A. 

or as an antiseptic 'application in root-canals. Silver nitrate 
may be used in the form of lunar caustic to touch ulcers 
appearing in the mouth, or in full strength to obtund hyper- 
sensitive dentin. It has also been recommended, in 50% solu- 
tion, in the treatment of pulpless canals. Tincture of aconite 
is used as a sedative application in pericementitis; also, to 
control an aching pulp, and as an ingredient of ointments 
for neuralgia. Capsicum is used as a counter-irritant in peri- 
cementitis, and as a stimulating ingredient in mouth-washes. 

How is the muscular system affected in complete anes= 
thesia under ether and under nitrous oxide? 

Under ether the muscles are relaxed. Under nitrous oxide 
the muscles are contracted. 

What are the advantages and disadvantages in the use 
of chloroform as an anesthetic in tooth extraction? 

The anesthesia resulting from inhalations of chloroform is 
prolonged, affording free opportunity for the removal of any 
number of teeth. The disadvantages are decided. The up- 
right position is against the patient; and, furthermore, fail- 
ure of the heart's action is apt to result in consequence of the 
irritation of the pneumogastric induced through irritation of 
the fifth pair of nerves in the extraction. 

What is ethyl chloride? Describe method of producing 
local anesthesia by its use, and state precautions to be 
observed. 

Ethyl chloride is a volatile, colorless liquid with a boiling- 
point, of about 60° F. When a spray is directed against tissue 
it acts as a freezing agent by its very rapid volatilization. 
The tissue not to be affected should he protected against the 
spray. By the use of cold applications the tissue may be pre- 
vented from too quickly returning to a normal state, and thus 
lessen the incident pain which is usually felt after the use 
of chloride of ethyl. 



THERAPEUTICS AND MATERIA MEDICA. 233 

Give the precautions to be observed before and during 
the administration of nitrous oxide. 

The patient should be examined as to physical condition, 
and also as to what teeth or roots are to be extracted, so that 
no time is lost later. Care should be taken that sufficient 
nitrous oxide is at hand for the operation, and a third party 
should be present. The jaws should be kept separated. Dur- 
ing 1 the administration, the respiration should be carefully 
watched. Interference with respiration is the chief source of 
danger. As soon as the anesthetic state is induced, further 
administration should at once cease. 

Describe fully two methods for producing local anes- 
thesia. 

Hypodermically, with a 1% or 2% solution of" cocaine 
hydrochlorate, injecting about 20 minims of the 1% or 10 
minims of the 2% solution about the alveolar tissue; or by 
means of a spray of ethyl chloride, protecting the tissues not 
to be affected. The spray is directed until the tissues whiten. 
It is better not to allow a too rapid return to a normal con- 
dition of the anesthitized parts. This may be produced by 
directing the patient to hold cold water in the mouth. 

Describe methods of procedure and precautions neces- 
sary in hypodermic injections for producing local anes- 
thesia. 

The parts to be operated upon should be treated antisep- 
tically, so that no adherent septic matter is carried into the 
subtissues. The needle and solution should be perfectly 
aseptic. Care should be taken not to penetrate a blood-vessel. 
After injection the fluid should not be allowed to escape. 
The proper quantity and no more should be injected. 

How is anesthesia modified by age, sex and tem- 
perament? 

In children we find a ready response to the inhalation of 
anesthetics. When ether is used, a hypersensitive mucous 



284 THERAPEUTICS AND MATERIA MEDIC A. 

surface in the pharynx and Larynx induces coughing; in the 
aged, chronic bronchial irritation is apt to produce the same 
result. Women are apt to give manifestations of hysterical 
tendencies. Sex and temperment may influence the amount 
necessary to induce anesthesia. The stage of excitement may 
be prolonged in hysterical subjects, and also in those of bilious 
attributes. 

What anesthetic do you prefer, and for what reason? 

For the extraction of teeth and minor operations in the 
mouth that require little time for their execution, nitrous 
oxide is the safest anesthetic we have at the present time. 
From a most extended experience during which hundreds of 
thousands of patients have been placed under its influence, 
the death rate is practically nil. 

Mention the differences between cocaine and eucaine. 

Cocaine is an alkaloid, soluble to the extent of over 30% 
in water, decomposes upon boiling, and frequently is fol- 
lowed by poisonous symptoms, Eucaine is s,\ nthetically pre- 
pared; is soluble to the extent of about 4% in water, does 
not decompose when subjected to heat, and its use is not so 
frequently followed by dangerous symptoms. 

At what period in nitrous oxide anesthesia may you 
have failure in circulation? 

After the anesthetic stage, owing to anemia of the brain. 

What causes the darkened appearance of the patient 
under nitrous oxide, and state in what manner this may 
be lessened? 

The accumulation of carbon dioxide. Giving oxygen in 
combination with nitrous oxide will considerably lessen the 
bluish appearance of the countenance. 

What is liquid nitrous oxide? 

The gas nitrous oxide liquefies when subjected to a pressure 
of about 700 pounds at a temperature of about 45° F. 



THERAPEUTICS AND MATERIA MEDIC A. 235 

What is the appearance of the face under ether an= 
esthesia? 

Generally flushed. 

What appliances should he at hand and in readiness 
when anesthetics are used? 

Hypodermic syringe, with various respiratory and circula- 
tory stimulants. Also the facilities for performing artificial 
respiration. 

How is bromide of ethyl administered, and what is 
its action? 

The quantity to be administered is poured out upon a towel 
(about 2 drachms) and inhaled by the patient. Bromide of 
ethyl resembles chloroform in its action upon the heart. It 
interferes with the function of the red corpuscles, and affects 
consciousness last; in many cases patients are conscious and 
yet not perceptive of any pain. The anesthesia generally 
lasts about five minutes. 

What strength of solution of cocaine would you employ 
for hypodermic use, and how much of the solution would 
you use? 

Generally 1% or 2% solution is employed. 20 minims of 
the 17c or about 10 minims of the 2% solution may be in- 
jected. 

Give the antidote of the following drugs, (a) iodine, 
(b) bichloride of mercury, (c) arsenic, (d) phosphorus. 

(a) Starch, (b) albumin, (c) hydrated ferric oxide (freshly 
prepared), (d) turpentine. 

Mention two drugs insoluble in water. 

Bismuth subnitrate and mercurous chloride. 

What alkaloids are found in opium? What is its active 
principle? 

Morphine, codeine, narcotine, thebaine. 

The most important active principle is morphine. 



236 THERAPEUTICS AND MATERIA MEDICA. 

What is meant by a mydriatic? Name one. 
A mydriatic is an agent which causes dilatation of the 
pupil of the eye, e. g., belladonna. 

What is meant by a synergist? Name the synergists 
of aconite. 

A synergist signifies an aid. Veratrum viride, tartar emetic 
or bromide of potassium act as synergists to aconite. 

What is a cathartic, and how are cathartics divided? 

Cathartics are agents which produce evacuation of the in- 
testinal tract. They may be arranged according to the sever- 
ity of the effect. Laxatives are the mildest, purgatives are 
more severe, and drastics most severe in their action. 

Give the treatment of poisoning from cocaine. 

Fresh air, inhalations of nitrite of amyl or ammonia. 
Alcohol, (brandy or whisky.) aromatic spirits of ammonia, 
strychnine, digitalis and atropine, hypodermically or by the 
mouth. External heat. 

State the local action of cocaine on the blood vessels. 

Cocaine applied to a mucous membrane or injected under 
the skin causes tlie blood-vessels of the part to contract. As 
the effect passes off. the reaction results in dilatation. 

Name three mineral acids employed in dentistry and 
give their properties and uses of each. 

Hydrochloric Acid. — The strong acid is a powerful caustic 
and escharotic; also disinfectant and fumigant. The dilute 
acid is tonic, refrigerant and astringent. 

The strong acid is employed as a local application in gan- 
grenous stomatitis, or cancrum oris, for arresting the ulcera- 
tive process. Combined with equal parts of glycerine it is 
useful in inflammation and ulceration of the oral mucous 
membrane ; also in cases of sloughing. In aphthous ulcera- 
tion of the mouths of children, it is often useful. 

Nitric Acid. — Pure nitric acid is a powerful caustic and 



THERAPEUTICS AND MATERIA ME DIVA. 237 

escharotic. The dilute acid is an antalkaline, alterative, tonic 
and refrigerant. 

The strong* acid, when mixed with two parts of hydro- 
chloric acid, is a solvent for gold. It is employed as a caustic 
in cancrum oris; also for malignant ulcers of the mouth 
and for devitalizing pulp of teeth when nearly exposed by 
mechanical abrasion. 

Sulphuric Acid. — The strong acid is a powerful escharotic, 
the dilute acid is refrigerant, astringent and tonic. The con- 
centrated sulphuric acid is used as a caustic in malignant 
ulcers, cancrum oris and gangrene in the form of a paste, 
made by mixing it with powdered sulphate of zinc. It is also 
used to cleanse metal plates. The dilute acid or the aromatic 
sulphuric acid which is more agreeable, is used in pyorrhoea 
alveolairis, and in caries and necrosis of the maxillary bones, 
as an injection or lotion. It is also employed in cases of re- 
cession of the gums and absorption of the processes. It is 
valuable in alveolar abscesses as an injection. It is employed 
in stomatitis and ulcers of the mouth. 

Mention (a) two heart stimulants, (b) two heart seda- 
tives. State the dose of each. 

(a) Aromatic spirits of ammonia, 20 minims to 1 drach. 
Whisky, 2 drachms to 1 ounce. 

(b) Tincture of aconite, 1 to 5 minims. Tincture of vera- 
trum viride, 3 to 30 minims. 

Mention three medicines used to produce emesis and 
state how each is administered. 

Sulphate of zinc, 10-30 grs. by mouth. 

Mustard, 1 to 2 drs. by mouth. 

Apomorphine hydrochlorate, T V~s £''• hypodermically. 

Mention three medicines used to produce diaphoresis. 

Pilocarpine, tartar emetic, and Dover's powder. 

What is the local action of chloroform? 

Placed on the skin and allowed to evaporate it produces a 



288 THERAPEUTICS AND MATERIA MEDICA. 

sensation of cold. If the vapor be confined it causes irri- 
tation with redness and even vesication, accompanied by a 
sensation of heat, followed by numbness and a decreased sen- 
sation of the part. 

Define materia medica, therapeutics. 

Materia medica treats of the source of drugs, their phys- 
ical and chemical properties, and may also include their 
physiological action. 

Therapeutics treats of the application of remedial agents 
to disease. 

In what ways may medicines enter the system? 

Mouth, rectum, respiratory tract, absorbed through the skin 
and injected under the skin. 

Name two drugs whose poisonous action is markedly 
manifest in the mouth. Give the distinguishing char- 
acteristics of the effects of these drugs. 

Iodides and mercury. 

lodism is manifest by swelling and redness of the gums, 
fauces, hard and soft palate, foulness of the tongue, fetid 
breath, and increase of mucus in the mouth: also headache. 
coryza and increased bronchia] secretion. Mercury may in- 
crease the salivary Mow to several pints per day. At first 
the secretion is thick, but later becomes thin. Fetid breath, 
sore gums, may go on to ulceration of the mouth and cheeks. 
Low fever. 

Which of the vital organs fails first in collapse from 
(a) ether, (b) chloroform? 

(a) Kills by paralysis of respiratory center, (b) usually 
the heart, but may be respiratory center. 

Name two medicines that decrease blood pressure. 

Tartar emetic and tincture of aconite. 

Describe the method of administering a medicine by 
which its quickest action is obtained. 

The medicine in solution is placed in a hypodermic syringe 



THERAPEUTICS AND MATERIA MED1CA. 2:5!) 

(the syringe and solution being as near aseptic as possible). 
The air is expelled while the needle points upward, sterilize 
the skin and inject contents into the cellular tissue. 

Define diuretic, diaphoretic, expectorant. 

Diuretics are agents which increase the flow of urine. 
Diaphoretics increase the perspiration. Expectorants in- 
crease and modify the secretion of the bronchial mucous 
membrane. 

Differentiate a tonic and a stimulant. 

Tonics promote secretion and give tone to the system. 
Stimulants increase the function of the part or organ. 

Mention two medicines that may be used as cauteries. 

Nitrate of silver and carbolic acid. 

State the treatment of carbolic acid poisoning. 

Administer a soluble sulphate (sodium or magnesium) and 
follow by albumin and mucilaginous drinks. Wash out the 
stomach. Combat collapse by external heat and with hypo- 
dermic injections of strychnine and atropine. 

What is an emetic? 

Kinetics are agents which excite vomiting either by local 
or central action. 

Mention two drugs that reduce fever. 

Acetanilid. Quinine. 

Describe the symptoms of cocaine poisoning. 

A rapid, feeble and irregular pulse, with shallow and 
labored respiration, clammy skin, dilated pupils, delirium and 
hallucinations. May have clonic convulsions and increased 
temperature. 

What restoratives are most desirable in case of threat- 
ened collapse during the administration of (a) Nitrous 
Oxide, (b) Ether, (c) Chloroform. 

(a) A.myl nitrite, oxygen, atropine. 



240 THERAPEUTICS AND MATERIA MEDICA. 

(b) Ammonia, oxygen, strychnine, atropine and faradie 
current. 

(c) Ammonia, strychnine and digitalis. 

What is the antidote for opium? 

Potassium permanganate (chemical). Atropine (physio- 
logical). 

What is the dose of bichloride of mercury? 

<nr to & gr. 

Mention two purposes for which medicines may be 
applied cataphorically in dentistry. 

For painless tooth extraction, and to antisepticize pulp- 
canals. 

What medicines are indicated and about how long 
should they be applied cataphorically for the purposes 
mentioned in the preceding question. 

(a) Cocaine, (b) silver nitrate, 8 to 20 minutes. 

Mention three saline cathartics and state the dose of 
each. 

Sulphate of magnesia (Epsom salt), 1 drachm to 1£ ounces. 
Tartar of potassium and sodium (Roc'helle salt), 1 drachm 
to 1 ounce. 

Solution of citrate of magnesia, 12 ounces. 
Mention three good counter-irritants. 
Oantharides, tr. of iodine, and mustard. 

Define chemical antidote for a poison, physiological anti- 
dote for a poison. 

By chemical antidote is meant some substance which com- 
bines chemically with the poison, producing an inert or in- 
soluble compound. By physiological antidote is meant a sub- 
stance which is opposed to the poison in its action on the 
economy. 

State three properties of carbolic acid. 

Local anesthetic, caustic and antiseptic. 



THEBAPEUTICS AND MATERIA MEDIC A. 241 

Name the antacids valuable for use in the mouth. 

Sodium bicarbonate, lime-water, ebalk and charcoal. 

What is the chief use of capsicum in dentistry? 

As tincture or plaster in periodontitis. 

What is meant by chemical and physiological incom= 
patibility of medicines? 

Agents are said to be chemically incompatible when their 
mixture results in t'he decomposition of one or more of the 
ingredients. 

Physiological incompatibility is where one drug produces 
effects upon the system opposite to the action of some other 
drug, like aconite and opium. 

Give the physiological action of belladonna. 

Belladonna is an anodyne, an antispasmodic, a mydriatic, 
an irritant narcotic ; in small doses a respiratory, cardiac, and 
spinal stimulant ; in large doses a paralyzer of the secretory 
and motor nerve endings, and a stimulant of the sympathetic 
system. It produces dryness of the mucous membranes of the 
nose, mouth, throat and larynx; and at first lessens the gastric 
and intestinal secretions, but soon reproduces them in large 
quantity. The heart-rate is at first slowed, but soon becomes 
vigorous and rapid. 

Give the mouth signs of mercurial poisoning. 

Hyperemic mucous surface, teeth tender upon pressure and 
loose, increased flow of saliva, swollen tongue, and metallic 
taste. 

How should the administration of chloroform differ 
from that of ether? 

Chloroform should be administered a few drops at a time 
and the vapor allowed to mix freely with air, while ether is 
administered in larger quantities and only a small 'amount 
of air allowed to mix with the vapor. 
16 



242 THERAPEUTICS AND MATERIA MEDIC A. 

State the objection to the use of iron salts as styptics. 

The clot which is formed is soluble in the fluids of the 
mouth, frequently resulting in secondary hemorrhage. Iron 
solutions used are also strongly acid. 

Mention, with doses, three coal=tar preparations, useful 
in the treatment of neuralgia. 

Acetanilid, 2 to 10 grs. ; p'henacetin. 2 to 10 grs. ; anti- 
pyriue, 5 to 10 grs. 

Differentiate poisoning by atropine and poisoning by 
strychnine. 

In atropine poisoning we have motor paralysis, delirium 
and death. In strychnine poisoning we have convulsive ac- 
tion of the muscles with consciousness. Death follows from 
exhaustion and asphyxia. 

Write a prescription for an antiseptic mouth-wash. 

R Acidi carbolici (95%) raxn 

Aquae q. s. f 3 v 

Sig. — Use as raouth-wasli. 

What is meant by the active principles of a drug? Give 
an example. 

The extractive substance which gives the drug its medicinail 
properties. Quinine is an active principle of cinchona bark. 

Mention three alteratives. 

Arsenic, mercury and iodine. 

Give the physiological action of ergot. 

Externally it acts as a slight astringent on the broken skin 
or mucous membrane. 

Castro-intestinal Tract. — Disagreeable taste and may pro- 
duce nausea and vomiting. 

Circulation. — Heart-beat becomes slow and increased in 
force. It stimulates the vaso-motor center and unstriped 
muscular fibres of arteries, raising blood-pressure. 

Uterus. — It stimulates the contraction of the parturient 



THERAPEUTICS AND MATERIA MED1CA. 243 

uterus, increasing the force and frequency. There is a marked 
decrease in the blood-supply of the non-parturient uterus. 

Nervous System. — It causes anemia of the centers, partic- 
ularly in the spinal cord. 

Give the physiological action of digitalis. 

Castro-intestinal Tract. — Digitalis may cause nausea, vom- 
iting and diarrhoea. 

Circulation. — Decreases the number of heart beats, length- 
ening diastole (stimulation of inhibitory fibres of vagus). It 
increases the force of the contractions (intrinsic ganglia). 
Arterial tension rises from increased cardiac force, excitation 
of vaso-motor center, and direct action on the muscular coats 
of the arteries. By relaxation of renal arteries it increases 
flow of urine. Later the heart becomes weak and irregular, 
beating with increased frequency. Large doses decrease ab- 
normal temperature. It may cause headache, vertigo or de- 
lirium. It also stimulates the uterine contractions. 

Give the physiological action of nux vomica. 

Castro-intestinal Tract. — Small doses act as a bitter tonic, 
increasing appetite, secretion and digestion. It increases the 
muscular tone of the stomach and peristalsis is also increased. 

Circulation. — Cardiac center, vaso-motor center and cardiac 
ganglia are stimulated, raising arterial tension, increasing the 
force of heart action but slowing its beat. The respiratory 
center is stimulated, the pupils dilated, the contractile power 
of the bladder is stimulated, the reflex activity of the spinal 
cord is increased. It also acts as an aphrodisiac. 

Give the physiological action of opium. 

Externally it is slightly sedative. 

Stomach. — It decreases sensation, secretion and peristalsis, 
reducing hunger and pain. Continued use deranges digestion. 

Intestines. — Sedative action, relieving pain, secretion de- 
creased and peristalsis is decreased by stimulation of the 
splanchnics (inhibitory nerves). Large doses may cause diar- 



244 THERAPEUTICS AND MATERIA MED1CA. 

rhoea leading to paralysis of the splanchnics. Bile and pan- 
creatic juice are decreased. 

Nervous System. — The convolutions of the brain are briefly 
excited, then depressed by direct action on nerve cells (pos- 
sibly by causing anemia). 

Stage of Excitement. — Exaltation of feelings, happiness, 
brilliancy of imagination, increase of intellectual power and 
mental vigor. Imagination becomes extravagant, dreams of 
grotesque and impossible things. Sensory and perceptive 
centers become depressed, stupor and sleep. Pupils contracted. 

Write a complete prescription for a four=ounce aqueous 
solution containing three drugs, (b) State the amount of 
each drug contained in a teaspoonful of the solution. 

For John Smith. 

A. Potassii bromidi gr. clx 

Chloralis gr. lxiv 

Tincture digitalis m. zlviii 

Aquae, q. s. ail f $ iv 

M. Sig. — Teaspoonful in water every hour until relieved. 
10-29-'04. Dr. D . 

(b) Potassium bromide, 5 grs. ; chloral, 2 grs. ; tincture of 
digitalis, 1^ minims. 

Under what conditions is ether contra=indicated as an 
anesthetic? 

In acute inflammatory infections of the respiratory tract, 
advanced arteriosclerosis, severe nephritis, especially when 
associated with cardiovascular lesions and anemia when the 
hemoglobin is less than 30%. Diabetes mellitus, especially 
when well established and associated with acetonuria (Ste- 
vens) . 

Name the most common aftereffects of the administra* 
tion of ether. 

Nausea and vomiting. 

Name the accidents that may happen during the admin- 
istration of ether, and give the treatment in each case. 

In the early part of the administration of ether we may 



THERAPEUTICS AND MATERIA MEDIC A. 24o 

have failure of respiration, which is due to reflex spasm of 
the laryngeal muscles excited by the ether. By giving more 
air with the ether we can correct this trouble. 

Embarrassed respiration may be due to the accumulation 
of mucus in the upper air-passages. In this condition we 
simply turn the head to one side. 

Respiratory failure may be caused by the action of the 
ether on the respiratory center. In this case we withdraw 
the ether; push the jaw forward by pressing on its angles, 
draw the tongue forward by means of a tenaculum or forceps 
and make rhythmic traction of the tongue. Pour ether on 
the abdomen or chest in order to stimulate inspiration by 
reflex action, give strychnine and atropin hypodermically. 
Practice artificial respiration. 

When is chloroform preferred to ether as an anesthetic? 

In acute inflammation of the bronchi or lungs, aneurism, 
atheroma and nephritis. 

Give the signs of danger in chloroform anesthesia and 
tell what should be done. 

Lividity of the face, irregular or stertorous breathing or 
feebleness of the pulse. Withdraw the anesthetic, lower the 
head, use artificial respiration and give a hypodermic injec- 
tion of strychnine, digitalis, or ammonia. 

What are topical remedies? (b) Mention two classes, 
(c) Give two examples of each. 

Topical remedies are those which are applied locally. 

(b) Plasters and liniments. 

(c) Belladonna plaster and capsicum plaster — turpentine 
liniment and chloroform liniment. 

What systemic conditions contra=indicate the use of 
nitrous oxide gas? (b) State why? 

Atheromatous vessels, fatty heart and pulmonary emphy- 
sema (Burchard). 

(b) Nitrous oxide gas increases blood pressure, and in 



246 THERAPEUTICS AND MATERIA MEDICA. 

atheromatous degeneration of the arteries this may result in 
rupture of these vessels, and if in the brain, apoplexy or early 
death may ensue. 

In fatty heart the muscles are weakened, and on account 
of the increased resistance in the blood-vessels there may be 
sudden dilatation of this organ. 

In pulmonary emphysema the danger is in the engorgement 
of the blood-vessels of the lungs, which causes an increased 
resistance to the right heart, which may result in the sudden 
dilatation of this organ, or there may be pulmonary edema or 
hemorrhage. 

Give the indications for the use in producing sleep of 
(a) morphine, (b) chloral, (c) potassium bromide. 

(a) Morphine is used when sleeplessness is due to pain. 

(b) Chloral is indicated when sleeplessness is due to mental 
overwork and where a more powerful hypnotic than potas- 
sium bromide is required. If the heart or stomach are in 
bad condition it should not be given. 

(c) Potassium bromide is given when insomnia is caused 
by cerebral excitement, nervous excitement (especially when 
connected with the genital function) and motor activity. 
According to Wood it is contra-indicated by an excessive 
irritability of the gastro-intestinal mucous membrane and 
great exhaustion. 

What is an analgesic? Mention three. 

An analgesic or anodyne is an agent which relieves pain. 
This may be accomplished by local or central action. Opium, 
cocaine and chloroform are examples. 

Why is the use of ether as an anesthetic contra-indi= 
cated in diseases of the lungs and kidneys? 

Because it is eliminated by the lungs and kidneys, and on 
account of its irritating qualities it would aggravate the dis- 
eased condition. 

Decribe the three stages of chloroform narcosis. 

1st stage. — This stage is very short and the symptoms are 



THERAPEUTICS AND MATERIA MED1CA. 247 

very similar to those of alcoholic intoxication. Consciousness 
is not lost but the sensibility is generally dulled, but rarely 
altogether abolished. 

2d stage. — This is the stage of anesthesia; consciousness 
and sensibility are abolished, the muscles are relaxed and the 
patient is quiet, The pulse is generally normal in frequency, 
but somewhat weakened. 

3d stage. — This stage is one of profound narcosis, with 
stertorous breathing, intense muscular relaxation, abolition of 
the ordinary reflexes, and fall of bodily temperature. Pulse 
is weak and rapid. 

Give the contraindications to the use of anesthetics. 

Organic brain disease, including tumors, atheromatous con- 
ditions of the blood-vessels, organic affections of the heart, 
luugs and kidneys (Wood). Some authorities add diabetes 
nielli tus, chronic alcoholism and enlarged tonsils. 

Describe the three stages of anesthesia under ether. 

1st stage. — Burning the fauces, feeling of strangulation, 
sense of exhilaration, lightness in the head with a buzzing or 
roaring in the ears. These symptoms are soon followed by a 
feeling that the surroundings of the patient are at a distance, 
which fades into semi-unconsciousness with visions and illu- 
sions. Patients may laugh, shout, weep, fight or pray. 

2d stage. — This stage begins with a complete loss of con- 
sciousness. Muscular rigidity soon passes off and the patient 
is quiet. Respiration is slow and regular. 

3d stage. — Same as the third stage under chloroform nar- 
cosis. 

Name the ingredients of a desirable dentifrice and 
specify the properties that make each of these ingredients 
desirable. 

Precipitated chalk gives body, is abrasive and also antacid. 
Orris root gives flavor and masks the soap. 
Powdered soap is antiseptic and removes fatty film from 
the teeth. 



248 THERAPEUTICS AND MATERIA MEDICA. 

Saccharine sweetens, and disguises earthy taste of chalk. 
Menthol is strongly antiseptic and cooling. 

What is meant by cataphoric application of a remedy? 

By cataphoric application of a remedy is meant the infil- 
trating of the tissue with some drug by electrical osmosis. 

Differentiate a decoction, an infusian and a tincture. 

Decoctions are solutions of the active constituents of drugs 
obtained by boiling them with water. 

Infusions are aqueous solutions of the medicinal constit- 
uents of plants, obtained by infusing the drug with hot water, 
the drug not being subjected to boiling. 

Tinctures are solutions of non-volatile substances in alcohol. 

Differentiate fixed oils and volatile oils and give three 
examples of each. 

Fixed or fatty oils are permanent liquids, or at certain 
temperatures solid substances, not volatilized by heat, and 
leave greasy stain on paper. They consist mainly of varying 
proportions of olein, palmitin, stearin. 

Castor, linseed and olive oils belong to this class. 

Volatile or essential oils, so called because they usually 
represent the odorous principles of plants, are entirely dis- 
sipated by exposure to the air or heat. They leave no stain 
on paper, have hot, pungent taste, but when diluted are 
agreeably aromatic. They consist of two principles — a solid 
stearopten, and a liquid eleopten portion. They are limpid 
fluids at ordinary temperatures. Oils of cloves, wintergreen 
and cinnamon belong to this class. 

What is hydrogen dioxide? Give its formula and dental 
uses? 

Hydrogen dioxide (U. S. P.) is a slightly acid, aqueous 
solution containing, when freshly prepared, about 3% by 
weight of the pure dioxide, corresponding to about 10% of 
available oxygen. Formula is H 2 2 . Its dental uses are to 
destroy pus and whenever a non-toxic disinfectant is indi- 
cated. 



THERAPEUTICS AND MATERIA MEDICA. 249 

What is iodoform? Give a solvent and state dental uses. 

Iodoform occurs as small, lemon-yellow crystals of a very 
persistent, disagreeable odor, made from the action of iodine 
on alcohol with potassium hydrate or carbonate. It is almost 
insoluble in water, very soluble in alcohol, ether, chloroform, 
fixed and volatile oils. In dentistry it is employed as a root- 
canal dressing. 

What is formaldehyde? State the dental uses and the 
strength of solution that should be used for each purpose. 

Formaldehyde is a colorless, irritating gas, produced by 
the oxidation of methyl-alcohol. It is very soluble in water 
and alcohol, and occurs commercially as a 40% aqueous solu- 
tion. It is used in dentistry in mouth-washes as an antiseptic 
in \ to 1% solution. 

Write two complete prescriptions, one containing a 
drug in aqueous solution and the other containing a drug 
insoluble in water, also in solution. 

For Miss Jones. 

r£ . Plumbi acetatis gr. v 

Aquse dist fjj 

M. Sig. — Use as directed. 

J. V. Doe. 

For Mrss . 

\& . Hydronapthol % j 

Alcohol f 3 j 

M. Sig. — Teaspoonful in wineglass of water, as a wash. 

J. V. Doe. 

What are fluid extracts? 

They are liquid, alcoholic preparations of drugs, permanent 
and concentrated to such a strength that 1 c.c. represents 
the equivalent of one gram of the drug. 

What is bromide of ethyl? 

Bromide of ethyl is a colorless, volatile liquid with ethe- 
real odor. Made by distilling a mixture of potassium bro- 
mide, alcohol and sulphuric acid and purifying the distillate. 



250 THERAPEUTICS AND MATERIA MED1CA. 

Distinguish between narcotics and hypnotics. 

Narcotics are drugs, all more or less poisonous, which de- 
press the higher functions, lessen, and in large doses abolish 
sensibility to pain and cause sleep, which is usually followed 
by unpleasant symptoms. 

Hypnotics induce refreshing sleep with no untoward after- 
effects. They are cerebral sedatives. 

Write a prescription for a wash for a purulent antrum, 
using no proprietary terms. 

R. Sodium bicarbonate gr. xxx 

Thymol gr. v 

Alcohol f 3 iv 

Glycerine f 3 i 

Water, q. s f 5 iv 

M. Sig. — To be used as directed. 

Mention two heart stimulants administered by inhala- 
tion and state under what circumstances they are par- 
ticularly useful. 

Amyl-nitrite — in chloroform anesthesia should cardiac fail- 
ure occur. 

Ammonia — in syncope from any caust. 

What physical states of medicine are most suitable 
for different methods of administration? 

By mouth — solution, pill, powder or ■capsule. 

By inunction — liniment, ointment or plaster. 

By inhalation — vapor. 

By rectum — solution or suppository. 

By hypodermic injection — always in solution. 

Write a prescription for an astringent mouth wash, 
using no proprietary terms. 

R. Sodium bicarbonate gr. xxx 

Tincture of iodine f 3,j 

Tannic acid gr. xxx 

Water f f, vi 

Sig. — To be used as a mouth-wash as directed. 



THERAPEUTICS AND MATERIA MEDIC A. 251 

Mention three disinfectants suitable for use in putres= 
cent pulp canals. 

Formaldehyde. Carbolic acid. Bichloride of mercury. 

Mention a chemical antidote for carbolic acid. 

Magnesium sulphate. 

Define germicide, deodorant. 

Germicides are agents that destroy germs. 
Deodorants cover or destroy disagreeable odors. 

How do drugs produce emesis? 

Drugs produce emesis by acting on the stomach directly, 
afferent impulses stimulating the vomiting center in the me- 
dulla, and by stimulation of the center in the medulla itself. 

Write a complete prescription calling for three drugs 
which may be suitably combined. 

R. Acetanilid 3j 

Sodium bicarbonate 

Caffeine aa gr. xv 

M. et ft. chartae no. xii. 

Sig. — Take one every two hours. 

Define antipyretics. Mention three. 

Antipyretics are drugs which reduce temperature when 
abnormally high by retarding oxidation, by increasing heat 
dissipation, or by acting either on the heat-producing center 
of the brain or on the circulation. 

Acetanilid. Aconite. Quinine. 

Mention, with the dose of each (a) saline cathartic, 
(b) laxative cathartic, (c) cholagogue cathartic. 

(a) Magnesium sulphate, dose 2 to 8 drams. 

(b) Cascara sagrada (fluidextract), 15 to 60 minims. 

(c) Calomel in large doses, 2 to 10 grs. 

Mention three medicines used as styptics. 

Alum. Tannic acid. Solution of ferric subsidphate. 



252 THERAPEUTICS AND MATERIA MED1CA. 

Mention a medicine that stimulates absorption by the 
lymphatics. 

Potassium iodide. 

Mention three essential oils and state their dental uses. 

Oil of cinnamon — antiseptic root-canal dressing. 
Oil of cloves — to relieve toothache. 

Oil of wintergreen — for its agreeable taste and antiseptic 
qualities in dentifrices. 

Mention two agents used in bleaching teeth and de= 
scribe the method of their application. 

Sodium dioxide, if placed in a moist cavity, liberates nas- 
cent oxygen, thereby bleaching the dental tissue. Twenty- 
five per cent, pyrozone has similar action. 

What remedies, general or local, aside from operative 
procedure, are useful for the relief of toothache? (a) 
when the pulp is alive and not exposed? (b) when perice- 
mentitis has supervened on death of the pulp. 

(a) Oil of cinnamon. Oil of cloves. Tincture of aconite 
given internally in ^-drop doses. 

(b) Tincture of aconite and tincture of iodine in equal 
parts applied to the gum over the affected tooth. 

In death from ether, which of the vital organs fail first? 

The organs of respiration. 

Mention (a) a coagulating antiseptic, (b) a non=coagu> 
lating antiseptic. 

(a) Carbolic acid, (b) Oil of cinnamon. 

Define astringents. Mention two vegetable and two 
mineral astringents. 

Astringents are remedies which cause contraction of mus- 
cular tissue, coagulate albumen and lessen secretions from 
mucous surfaces. In weak solutions they act as tonics; in 
concentrated form they act as irritants and caustics. 

Vegetable astringents, tannic acid, krameria. 

Mineral astringents, alum, iron subsulphate. 



THERAPEUTICS AND MATERIA MEDICA. 253 

Define sialagogue. Mention one. 

Sialagogues increase the action of the salivary glands. 
Pilocarpine. 

Mention three alteratives and state the dose of each. 

Mercuric bichloride, ^V to T ^ gr. 

Potassium iodide, 5 to 60 grs. 

Fluidextract of stillingia, | to 1 fhiidrachm. 

What is meant by the physiologic action of a drug? 

The physiologic action of a drug is the altered action, func- 
tion, and behavior of the tissue and organs while under its 
influence. 

Arrange the following in the order of their efficiency as 
disinfectants; carbolic acid, bichloride of mercury, oil of 
cloves. 

Bichloride of mercury. Carbolic acid. Oil of cloves. 

Mention the drugs useful in the treatment of pyorrhea 
alveolaris and state their effects. 

Hydrogen peroxide attacks pus and dead tissue vigorously, 
destroying them by the liberation of oxygen. 

Hydro-naphthol is an efficient germicide for use after pus 
pockets have been otherwise cleansed. 

Aromatic sulphuric acid is useful to soften and remove 
calcareous deposits, besides having marked antiseptic and 
stimulating properties. 

Describe the physiological action of amyNnitrite. State 
the dose and the method of administering it. 

Amyl-nitrite stimulates the rate of heat-beats, though not 
their force ; vessels dilate, causing fall in arterial tension ; the 
respiration is first stimulated, but later depressed; action on 
the nervous system — great depression of motor centers ; tem- 
perature falls. 

The dose is three to five minims dropped on a napkin and 
administered by inhalation. 



254 THERAPEUTICS AND MATERIA MEDIC A. 

What is cocaine hydrochlorate? How is it obtained? 
State its properties and dose. 

Cocaine hydrochlorate is an alkaloid obtained from the 
leaves of Erythroxylon Coca by removing the tannin from 
an aqueous infusion of the drug with lead subacetate, and the 
addition of sodium or potassium hydrate to alkalinity. Then 
it is agitated with ether and the ethereal portion evaporated. 
It is finally purified by repeated crystallization from alcoholic 
solutions after having neutralized the salt with hydrochloric 
acid. It occurs as colorless, transparent, odorless, neutral 
crystals, bitter to the taste. It is soluble in half its weight 
of water or alcohol, less soluble in chloroform, and almost 
insoluble in sulphuric ether. It acts first as a stimulant, but 
later as a narcotic and depressant. Dose, £ to ^ gr. 

How many grains of a drug are necessary to make one 
pint of a i to 2000 solution? Write a prescription for 
a 1 to 2000 solution of bichloride of mercury. 

A pint of water weighs 7291.2 grains. A 1 to 2000 
solution contains ^sts °f a grain in every grain of water. 
Therefore, I -V lx ii 1 » =: number of grains in a pint of the 
solution; or 3.6456 grains. 

r£. Bichloride of mercury gr. 3.0456 

Distilled water f 3 xvi 

M. Sig. — Use as directed. 

Name three drugs useful for sterilizing instruments. 
Describe a method of sterilizing a mouth=mirror. 

Formaldehyde. Carbolic acid — 0% solution. Hydrogen 
dioxide. 

Sterilize a mouth-mirror by immersing it in a 10% solu- 
tion of formaldehyde for at least fifteen minutes. 

Name three heart stimulants administered hypodermi- 
cally in the order of their rapidity of action and state 
dose of each. 

Strychnine sulphate, dose ^V gr. 
Nitroglycerine, dose -j-J-^ gr. 
Alcohol, dose 30 minims. 



THERAPEUTICS AND MATERIA MEDICA. 255 

What remedies should always be at hand to meet symp- 
toms of danger in giving anesthetics? 

Aromatic spirits of ammonia ; hypodermic tablets of strych- 
nine sulphate; amyl-nitrite ; tincture of digitalis; alcohol 
(whisky or brandy); nitre-glycerin ; atropine. 

Give maximum dose of cocaine hydrochlorate for hypo- 
dermic administration to an adult. 

One-half grain. 

Describe carbolic acid and cresote. (a) Where de- 
rived? (c) Their dental use. 

Carbolic acid occurs as clear, colorless (when fresh) inter- 
laced, needle-like crystals, which, after exposure to light ac- 
quire a pink to reddish tint. It liquefies by heat or on addi- 
tion of 10% of water or glycerine; has distinctive, slightly 
aromatic odor, and when diluted has a sweetish pungent taste. 
It has faint acid reaction, is soluble in alcohol, glycerine or 
water, and coagulates albumin. Carbolic acid is obtained 
from coal-tar by fractional distillation and subsequent purifi- 
cation. In full strength it is used for hypersensitive dentin, 
and in pulpitis as an anodyne. In carious cavities and 
putrescent pulp-canals it is useful as a germicide, antiseptic 
dressing, and as a caustic in treating ulcers. A 5% solution 
may be used as an antiseptic for sterilizing instruments, and 
in weaker solution as an antiseptic mouth-wash. 

Creosote is an almost colorless, highly refractive, oily liquid, 
turning red or brown on exposure to light. Its odor is pene- 
trating and smoky, with burning caustic taste. It is slightly 
soluble in water, fully so in alcohol, chloroform, ether and 
oils ; does not coagulate albumin. 

It is derived from the fractional distillation of wood-tar, 
that portion coming over between 205 and 220 degrees (Cen- 
tigrade) being collected as creosote. Its dental uses are very 
similar to those of carbolic acid, though not suitable for 
sterilizing instruments nor as a mouth-wash, because of its 
insolubility in water. 



256 THERAPEUTICS AND MATERIA MEDICA. 

Write a prescription for a counter-irritant containing 
three drugs. 

R. Tincture of aconite 
Tincture of iodine 

Chloroform aa f z i 

M. Sig. — Apply as directed. 

How do cocaine and eucaine differ in physiological 
action? 

Eucaine has a very similar action to cocaine but does not 
dilate the pupils nor interfere with accommodation. It does 
not affect the circulation nor respiration to any great extent 
as does cocaine. 

Name five essential oils used in dental practice. 

Oil of cinnamon, oil of cajuput, oil of cloves, oil of winter- 
green, oil of eucalyptus. 

(a) What are local anesthetics? (b) Mention three, 
(c) Describe the method of using them, (d) State the 
precautions necessary. 

(a) Local anesthetics are agents which produce insensibil- 
ity of the part to which they are applied. 

(b) Cocaine hydrochlorate, ethyl chloride, carbolic acid. 

(c) Cocaine hydrochlorate is used hypodermically in 1 to 
5% solution. Ethyl chloride is used as a spray. Carbolic 
acid is applied to the surface in solutions up to 10% for its 
benumbing effect, which lasts several hours. 

(d) In the use of cocaine hydrochlorate hypodermically, 
have the syringe and solution perfectly aseptic, taking care 
not to inject an overdose. Have triturates of ^ u grain of 
atropine sulphate always at hand, also morphine sulphate as 
antidotes. 

In the use of ethyl chloride care should be taken not to 
freeze the tissue too hard. 

In carbolic acid as an anesthetic, solutions stronger than 
10% irritate and have caustic effects. 



THERAPEUTICS AND MATERIA MED1CA. 257 

What is trichloracetic acid? (b) What are its prop- 
erties and dental uses? 

(a) It occurs as colorless crystals, very soluble in water, 
obtained by the oxidation of chloral by nitric acid. 

(b) It is of value in the quantitative estimation of albumin 
and as a caustic. Its dental uses are as an aid in removing 
calcic deposits, and in treatment of suppurating surfaces. 

Describe the properties, dental use and application of 
copper sulphate. 

Copper sulphate occurs in large, blue crystals, permanent 
in the air, is odorless, and has a bitter, metallic taste; it is 
soluble in about three parts of water. In strong solution it 
acts as a caustic and in dilute form as an astringent. Inter- 
nally in doses of 5 to 10 grs. it is a certain and powerful 
emetic. 

Dental use — valuable for its astringent properties. 

(a) From what is opium obtained? (b) Name two of 
its alkaloids, (c) State the adult dose of each. 

(a) Opium is the inspissated milky exudate obtained by 
the incision of the unripe capsule of Papaver Somniferum. 

(b) Alkaloids— morphine and codeine. 

(c) Dose — morphine, \ to J gr. ; codeine, \ to 2 grs. 

Write a prescription for the treatment of thrush, con- 
taining at least two drugs and a menstruum. 

Ii . Boracic acid % j 

Carbolic acid m v 

Glycerine 

Water aa f giv 

Sig. — Use as a wash. 

How many grains of a drug are there in six fluid ounces 
of a io% solution? 

A fluidounce of distilled water contains 455.7 gr. Six 
rluidounces therefore contain 2734.2 gr. 

A 10% solution must therefore contain 27 1 8 o 4 ' 2 } or 273.42 gr. 
17 



258 THERAPEUTICS AND MATERIA MEDIC A. 

What is the dose of carbolic acid for internal admin- 
istration? What are the chemical antidotes? 

Dose is \ to 2 grs. 

Chemical antidotes — albumin and sulphate of sodium or 
magnesium. 

Describe the action of a saline cathartic. Name three 
and give the dose of each. 

Saline cathartics act by generally stimulating the secretion 
of intestinal fluids. This, together with increased peristaltic 
movements, results in easy evacuation. 

Magnesium sulphate ; dose, \ to 1\ ounces. 

Potassium and sodium tartrate ; dose, J to 1 ounce. 

Sodium phosphate; dose, \ to 1 ounce. 

Define diffusible stimulants, (b) Give three examples 
and mode of administering each. 

Diffusible stimulants are stimulants which have a prompt 
but transient effect. 

Ammonia — by inhalation. 

Ether — by mouth or hypodermic injection. 

Alcohol — by mouth or hypodermic injection. 

Write a prescription containing an anodyne, a styptic, 
and an antiseptic to be used after extensive extraction 
of teeth. 

For Mrs. Carpenter. 

K- Acidi tannici 3'' 

Acidi carbolici gr. xxx 

Sodii hydratis gr. x v 

Glycerini fgiv 

Aquae f % iiiss 

M. Sig. — Use as a mouth-wash. 

Dr. . 

Give a rule for determining the amount of a drug re= 
quired to prepare a solution of a given percentage. 

Multiply the amount (expressed as grains) of the finished 
solution by the per cent, given, and divide by one hundred. 



THERAPEUTICS AND MATERIA MEDICA. 259 

The quotient will be the quantity in grains of the drug re- 
quired. 

In what order are the nerve centres affected in general 
anesthesia? 

Nerve centers affected in general anesthesia are the brain, 
sensory side of spinal cord, motor side of spinal cord, and 
finally the nerve centers in the medulla. 

What are the physiological effects of nitrous oxide gas? 

It is a stimulating narcotic and anesthetic. 

There is an increase in blood-pressure, a sense of exhilara- 
tion, a ringing in the ears, followed by complete unconscious- 
ness. Anesthesia is probably due to the displacement of 
oxygen in the blood and to direct action of the gas on the 
cerebrum. 

Describe the preparation of nitrous oxide gas. 

Nitrous oxide gas is prepared by heating ammonium nitrate, 
the vapor of which is passed through three wash-bottles con- 
taining, respectively, pure water, solution of caustic potash, 
and solution of ferrous sulphate. 

State the dose, toxic effect, and antidote of arsenic, acon- 
ite and morphia. 

Arsenic, dose ^\ to ^ gr. 

Toxic effects are: faintness, nausea, epigastric tenderness, 
profuse diarrhoea, skin cold, pulse small and feeble. The an- 
tidote is freshly-prepared ferric hydrate. 

Aconite (Tincture) dose is ^ to 5 drops. 
(Solid extract) dose is $ gr. 

Toxic effects. — Tingling sensation in the mouth, vomiting 
later, skin cold and clammy, pupils dilated, pulse small, weak 
and irregular, muscular weakness, death from asphyxia. 

Antidote. — Emetics, artificial respiration, keep patient 
warm, stimulate with brandy, ether, digitalis, atropine. 

Morphia, dose ^ to \ gr. 

Toxic effects. — Pulse becomes slower, respiration is mark- 



260 THERAPEUTICS AND MATERIA MEDIC A. 

edly reduced, reflexes become abolished, death occurs from 
paralysis of the respiratory center, or carbonic acid accumu- 
lation in the blood. 

Antidotes. — Emetics in large doses, tannic acid as chemical 
antidote, strong coffee in stomach and rectum. 

Give the advantage and disadvantage of ether, chloro= 
form and nitrous oxide as general anesthetics. 

Ether. Advantages. — Administered with greater safety 
than chloroform on account of lessened tendency to cardiac 
failure. 

Disadvantages. — Tendency to produce struggling, and irri- 
tation to mucous membrane. It is highly inflammable, has 
disagreeable odor and is eliminated slowly. 

Chloroform. Advantages. — Not unpleasant odor, narcosis 
quickly accomplished without struggling, eliminated rapidly 
by the kidneys. 

Disadvantages. — Must be administered with great care as 
to admixture of air, contra-indicated in heart affections. 

Nitrous oxide. Advantages. — Pleasant to take, can be ad- 
ministered in sitting posture, nausea seldom occurs, dangers 
almost nil. 

Disadvantages. — Short duration of anesthesia, necessitating 
rapid operating. 

What is the physiological action and therapeutic use 
of arsenic? 

Physiological action. — Powerful caustic to all raw surfaces, 
gastro-intestinal stimulant in small doses; lessens the force 
and frequency of the heart's action; has great value in the 
treatment of chronic skin-diseases. Its dental use is for de- 
vitalization of the tooth-pulp. 

Describe the administration of nitrous oxide gas with 
precautions to be observed. 

Have patient remove all foreign substances from the mouth. 



THERAPEUTICS AND MATERIA MEDICA. 261 

See that mouth-prop is securely fastened with cord. Avoid 
administration to patients under the influence of alcohol or 
opiates. Use an inhaler which permits of the administration 
of air with the gas. 

What is the first manifestation of danger in ether 
anesthesia? 

Sudden cyanosis, respiratory failure, weak, rapid pulse. 

Name two drugs useful in failure of respiration under 
anesthesia. State properties, dose and how administered. 

Atropine, y^ grain. It increases rapidity and depth of 
respiration by stimulating the respiratory center. 

Strychnine, dose -^ to -£$ grain, hypodermically. It also 
stimulates respiratory center. 

Give method of administering ether and treatment in 
case of collapse. 

Open Method: Ether vapor given with large admixture 
of air. 

Closed Method. After first few respirations, ether vapor 
is given almost pure, only occasionally giving a breath of 
air. When full narcosis has been established, both methods 
are used alternately. In case of collapse, lower the head 
and raise the body, use artificial respiration, use inhalations 
of ammonia and amyl-nitrite, and injection, hypodermically, 
of strychnine, nitro-glycerin or digitalis. 

What are the advantages and disadvantages of local 
as compared with general anesthesia for extraction of 
teeth? 

Advantages in local anesthesia : less preparation of patient 
necessary, less time consumed, recovery immediate, no dread 
of unconsciousness, almost unlimited time for operation. 

Disadvantages are pain upon the insertion of a needle, pos- 
sibility of only partial anesthesia, and infection. 

Name three drugs or preparations useful in treating or 



262 THERAPEUTICS AND MATERIA MEDJCA. 

protecting recently exposed pulps before filling the 
cavities. 

Oil of cloves, campho-phenique, solution of menthol in 
chloroform. 

Describe the methods of administering cocaine to pro- 
duce anesthesia. 

Topical and hypodermatical. 

In topical application, cotton is saturated with a 10% 
solution of the drug, placed over the part and allowed to re- 
main until sensation disappears. 

In hypodermatic use a 1% to o'/c solution of the drug is 
injected into the part at various points. 

Is general or local anesthesia the more suitable in oper- 
ations about the mouth? Explain. 

Local anesthesia is preferable in operations about the mouth 
because of the free field of operation, unobstructed by the 
presence of apparatus used in general anesthesia. 

What remedies are useful for relief of toothache caused 
by near approach of caries to the pulp? 

Bicarbonate of soda in paste with glycerine, cocaine hydro- 
chlorate, essential oils. 



PHYSICS, CHEMISTRY AND 
METALLURGY. 



What is meant by specific gravity? 

Specific gravity, or relative weight denotes the weight of 
a substance as compared with the weight of an equal bulk, 
or equal volume, of another substance, which is taken as a 
unit or standard. 

Describe a hydrometer. 

A hydrometer is a cylindrical glass vessel weighted at the 
bottom, terminating above in a thin glass stem, which is 
divided into equal spaces called degrees, and the degrees are 
usually numbered from 1000 at the top of the stem increasing 
downward toward the center of the instrument. It is em- 
ployed to determine the specific gravity of liquids. 

What is water of crystallization? 

Water of crystallization is such water, in solid form, as 
gives to a substance its crystalline shape and, frequently, its 
color. It is not in chemical union with the substance, and 
leaves when substance is heated to 212° F. 

What is the difference between deliquescence and 
efflorescence? Give examples of each. 

Some solid substances have the power of absorbing moisture 
from the air and are called deliquescent ; such bodies may 
even be entirely liquified on exposure to air. The property 
certain crystallized substances have of losing water of 
crystallization when exposed to the air is known as efflores- 
cence; such bodies lose their crystalline outlines and become 

(263) 



26-4 PHYSICS, CHEMISTRY AND METALLURGY. 

powdery. Calcium chloride and gold chloride show deliques- 
cence. Common alum and ferrous sulphate are efflorescent. 

What is meant by the specific heat of a metal? 

The specific heat of a metal refers to the ratio between the 
quantity of heat a given weight of water contains, when 
both metal and water have the same temperature. It is 
often determined by observing the weight of ice melted by 
both the metal, and the same weight of water enclosed in 
a thin glass flask, when both, after being heated to the same 
temperature, cool to the same degree, in dried cavities in ice. 

Describe effervescence, hydrate, anhydride. 

Effervescence refers to the escape of a gas through a liquid, 
producing bubbling. A hydrate is a combination of a metal 
with a radical of the water type, as KHO. An anhydride is 
an oxide of an elementary substance, usually non-metallic, 
which will unite chemically with water to form an acid. 

Define elasticity. 

Elasticity is that property by virtue of which substances re- 
sume their former size and shape when they are relieved from 
the action of force upon them. 

Define separately the terms ductility, malleability and 
volatility, and give examples of each. 

Ductility is that property of matter by virtue of which it 
may be drawn into wire, e. g. gold, silver, platinum. 

Malleability is that property of matter by virtue of which 
it may be hammered or rolled out into sheets, e. g. gold, 
copper, tin. 

Volatility refers to the readiness with which substances pass 
into vapor, with or without heat, e. g. mercury, zinc, tin, 
iodine. 

Define anhydrous, alkaline, neutral. 

Anhydrous means deprived of water, as, anhydrous sulphate 
of copper. 

Alkaline refers to the property a substance has which, 



PHYSICS, CHEMISTRY AND METALLURGY. 265 

when in solution, turns red litmus-paper blue, unites with 
and neutralizes acids, forming salts; emulsifies fats, making 
soap, and possesses harsh acrid taste. 

Neutral refers to that condition in which a substance show- 
ing neither acid nor alkaline properties, does not affect 
litmus in color. 

Define tenacity. 

Tenacity refers to the strength or resistance substances 
show to mechanical force seeking to pull their molecules apart. 
The tenacity of a metal expresses its resistance to fracture 
from a tensile or stretching force. 

What is meant by spectrum analysis. 

Spectrum analysis is a method for recognizing the pres- 
ence of different substances owing to characteristic optical 
effects produced when such substances are viewed through a 
prism. The substance examined, if a metal, is usually heated 
to incandescence, when the light it yields passing through a 
prism gives rise to characteristic bands or lines of color lead- 
ing to its recognition. 

Describe the construction of two galvanic cells and 
mention the chemicals used in each cell. 

Grove cell: Hard rubber cup filled with dilute IL,S0 4 . con- 
taining "U" shaped strip of zinc. Immersed in this cup is 
a porous cup filled with strong nitric acid and a sheet of 
platinum. 

(irenet cell : This has two plates of carbon between which 
a plate of zinc may be raised out of, or lowered into the 
liquid, which latter consists of a mixture of sulphuric acid, 
potassium bichromate and water. 

What is meant by potential as applied to electric bodies? 

Potential represents the difference in positive and nega- 
tive conditions of a body, when its former condition of elec- 
trical equilibrium is disturbed by mechanical friction, as in 
rubbing glass, or molecular friction, as by chemical action. 



266 PHYSICS, CHEMISTRY AND METALLURGY. 

It represents a stored force, and is present before the wires 
are connected. It is to electricity what temperature is to heat. 
and is practically identical with tension and with electro- 
motive force. 

Describe in detail the process of electroplating. 

This term is usually applied to process of depositing a film 
of silver on surfaces of articles made of German silver, 
brass, etc. 

The article to be plated is cleansed by immersing it in hot 
solution of caustic potash, and afterwards (often) in acid, and 
is well rubbed with a scratch brush. 

It is then dipped in a solution of mercuric nitrate, rinsed 
in water, and at once suspended by thin copper wire in the 
plating trough, 'which contains a solution of silver cyanide 
with an excess of potassium cyanide, and is connected then 
with the negative pole of a battery. 

From the positive pole of the battery a strip of pure silver 
is suspended in the liquid near to the article to be plated. 

A current is now passed through the arrangement when 
the silver solution is decomposed and silver is deposited upon 
the article, while the pure silver strip slowly dissolves, form- 
ing cyanide of silver in the solution, thus restoring the 
strength in metal that the plating solution is losing. 

Describe the apparatus for generating electric currents 
from chemical action. State the chemical action involved 
in the process. 

A sheet of copper and a sheet of zinc placed in dilute sul- 
phuric acid will generate an electric current because the zinc 
will be acted upon chemically by the acid more than the 
copper. A solution of sulphate of zinc will form in the 
acid, and hydrogen gas will be liberated to settle in bubbles 
on the copper sheet. 

Explain the structure and luminosity of a candle flame. 

The flame of a candle presents three well marked zones, or 
portion, best shown by lowering wire gauze upon the flame. 



PHYSICS, CHEMISTRY AND METALLURGY. 267 

Viewed in such fashion we find the innermost zone to be 
colorless, of low temperature and composed of the vapors aris- 
ing from the heating of the wax of the candle. 

The second zone has the highest temperature, and is the 
luminous portion of the flame, and is occasioned by the burn- 
ing or oxidation of the vapors of the inner zone, and owes 
its luminosity to particles of solid carbon heated to incan- 
descence from the active chemical changes of oxidation. 

The outer zone has a low temperature, and is composed of 
water vapor, carbon-dioxide and amorphous carbon, as the 
final result of burning of the wax of the candle. It is dark 
in color. 

Describe the Bunsen burner and give the chemistry of 
its flame. 

The Bunsen burner consists of a tube for the burning of 
gas, at the bottom of which are apertures for the admission 
of air. The air so dilutes the gas that all of the carbon of the 
gas undergoes combustion ; carbon-dioxide and water result 
from burning. 

It presents two well marked zones of flame and a third 
surrounding very indistinct film. 

The inner flame is blue, pointed, of lower temperature and 
is known as the reducing flame, and its employment removes 
oxygen from bodies heated in it. 

The second flame is colorless, surrounds the inner flame, is 
of highest temperature, represents perfect combustion, is 
known as the oxidizing flame because metal heated in it readily 
combines with oxygen of the surrounding air. 

The film of practically invisible vapor surrounding these 
two flames is composed of water vapor and carbon-dioxide and 
has low temperature. 

Define cohesion, adhesion, gravitation. Mention in- 
stances in the action of each. 

Cohesion is an attractive force binding together molecules 
of like kinds and acts in the interior of bodies. Examples: 



268 PHYSICS, CHEMISTRY AND METALLURGY. 

cohesion combines the molecules of water into visible drops, 
unites the molecules of silica to form grains of sand, holds 
together molecules of gold to produce gold leaves. 

Adhesion is an attractive force binding molecules of unlike 
kinds together acting upon surfaces of bodies. Examples: 
water adheres to wood, glue to paper, alcohol to iodine. Both 
cohesion and adhesion require for their action that the sub- 
stances be practically in contact. Adhesion also unites masses. 

Gravitation is the attractive force which draws masses 
towards each other, acting when bodies are widely separated, 
as well as when in contact: Example, gravitation tends to 
keep the celestial bodies in their relative positions from the 
sun, occasions the fall of the apple from the tree to the earth, 
causes movement of the atmosphere. 

Describe the spectroscope and explain its use in a 
chemical analysis. 

A spectroscope consists of a tripod upon which is an optical 
prism and focused upon this latter are three telescopes, one 
of which is movable. A substance of unknown composition 
may be heated to incandescence before the distal end of one 
of the fixed telescopes and the light to which it gives rise 
enters through a narrow slit with parallel edges and passes 
through the prism. Here it is decomposed and the observer 
looking through the distal end of the movable telescope notes 
the effect of its decomposition of light from the object. 

The other immovable telescope is provided with a micro- 
meter scale which is reflected upon the prism by the light 
given by a burning candle placed at its distal end. 

This reflected scale allows the observer to locate any 
characteristic bands or lines of color or darkness that the light 
from the incandescent substance produces when passing 
through the prism. 

Thus, suppose a salt of unknown character to be heated 
to incandescence and when viewed by the observer through the 
movable telescope showed a field of blackness crossed verti- 
cally by a bright yellow line at a point in the scale marked 



PHYSICS, CHEMISTRY AND METALLURGY. 269 

"D, " this would serve to recognize the substance as a salt 
of sodium, or the metal itself. 

Mention some conductors and some non-conductors of 
electricity, and explain their behavior in connection with 
the electric phenomena. 

Good conductors of electricity; silver, copper and gold. 

Good non-conductors ; glass, silk, rubber. ■ 

A good conductor offers little resistance to the passage of 
electricity over its surface. 

A non-conductor offers great resistance or impedence to 
electric flow. 

A conductor only remains electrified when surrounded by 
non-conducting, or insulating, material. 

Non-conductors, when electrified as by friction, retain 
iheir electrical charge for a considerable time, but although 
a conductor may be electrified it instantly loses such charge. 

Describe destructive distillation and describe the gases 
generally formed during that process. 

Destructive distillation is the resolution of a complex sub- 
stance into simpler forms under the influence of heat, out 
of contact with air. 

Soft coal if heated in earthenware retorts connected with 
cooled receivers, so as to exclude air, would undergo destruc- 
tive distillation, giving rise to gases and vapors including 
hydrogen, marsh gas, carbon monoxide, carbon dioxide, 
olefiant gas, nitrogen, etc. 

Define matter, force, energy. 

Matter includes all which the senses appreciate as having- 
weight and occupying space. 

Force is that which produces motion, or tends to produce 
motion, or resists change. 

Energy is the capacity of any agent to do work. 

Distinguish the characteristics of matter in (a) the 
solid state, (b) the liquid state, (c) the gaseous state. 

(a) The solid state exhibits an independent form with 



270 PHYSICS, CHEMISTRY AND METALLURGY. 

cohesion strongly marked between the molecules, yet varying 
in degree so as to give rise to properties of hardness, ductility, 
malleability, tenacity, etc. 

Their shapes are often irregular; they do not unite after 
the passage through them of a cutting implement. They 
vary in elasticity. 

(b) In liquid state cohesive force is less marked although 
present. Liquids have no independent form, they unite after 
passage of a cutting implement, they present horizontal sur- 
faces, the particles move or flow freely over each other, they 
are perfectly elastic. 

(c) In gaseous state no independent form is present, co- 
hesion is absent, they unite after passage of cutting imple- 
ment, their particles tend to spread from each other, they 
exhibit tension or pressure, are perfectly elastic and uniformly 
compressible and expand equally when heated no matter what 
their composition. 

What is (a) a permanent magnet, (b) an electro- 
magnet? State how each may be made. 

(a) A permanent magnet is one made of steel which once 
magnetized retains its magnetic properties indefinitely. 

It may be made from a steel bar by rubbing the bar with 
an existing magnet in various ways. 

(b) An electro-magnet is one that quickly parts with its 
magnetic properties, and as quickly regains them. 

It consists of a bar of soft iron enclosed in a coil of in- 
sulated wire, and when an electric current passes through 
this coil the soft-iron bar becomes a magnet, but ceases to 
act as a magnet when the current of electricity no longer 
traverses the coil of insulated wire 

What physical forces have a tendency to decompose 
compound substances? Give examples. 

Heat; as in the decomposition of mercuric oxide into mer- 
cury and oxygen. 

Light; as in decomposition of silver chloride into sub- 
chloride of silver and chlorine gas. 



PHYSICS, CHEMISTRY AND METALLURGY. 271 

Electricity; as in the decomposition of water into hydrogen 
and oxygen gases. 

Differentiate sensible heat, latent heat, specific heat. 

Sensible heat is that appreciated by the senses and indicated 
by the thermometer and is a measure of the intensity of heat. 

Latent heat is not appreciated by sense of touch or the ther- 
mometer, bnt is the heat a body requires to affect its change, if 
solid into a liquid, or if liquid, into a gas or vapor. 

Specific heat is the amount of heat a body contains com- 
pared with the heat an equal weight of water contains, when 
the body in question and water are at the same temperature. 

Define capillary attraction, absorption, diffusion, osmose. 

Capillary attraction is a modified form of adhesion, by vir- 
tue of which liquids ascend in small tubes to which they ad- 
here, or descend in tubes that they cannot wet. 

Absorption refers to the including of a substance, usually 
liquid or gaseous, into another substance, usually solid or 
liquid, without material increase in size of the absorbing 
body; thus charcoal absorbs ammonia gas, water absorbs 
oxygen, etc. 

Absorption also refers, in optical phenomena, to the re- 
ceiving of light by a body but its failure to reflect or transmit 
such lig-ht or colors. Thus we speak of absorption spectra. 

Diffusion, if of liquids, is the gradual mixing of two liquids 
of different specific gravities when they are carefully placed, 
without mixing, in the same vessel, with the lightest liquid 
uppermost. 

Diffusion of gases refers to the intermingling or mixing 
of different gases. 

Osmose refers to the mixing of different liquids when separ- 
ated from each other by porous partitions. 

Define anode, cathode, circuit, electric current, induc- 
tive force, electro-motive force. 

Anode is the name applied to the end of a positive wire 
or pole leading from a battery. 



272 PHYSICS, CHEMISTRY AND METALLURGY. 

Cathode is the terminal of a negative wire or pole from a 
battery. 

Circuit is the pathway the electric energy is said to traverse 
from battery out along conduction material back into tin- 
battery. 

Electric current is the term applied to best describe the flow 
of electric energy from its source along its circuit. 

Inductive force is shown by the power of an insulated, 
charged conductor to act on nearby unelectrified bodies, as a 
magnet acts on soft iron. It decomposes their neutral electric 
fluid into positive and negative constituents, attracting to itself 
the unlike and repelling the like electric fluid. 

Electro-motive force is the force that sets electricity in mo- 
tion causing the current to leave the cell or dynamo. It is 
the result of the tendency to re-establish equilibrium be- 
tween quantities of positive and negative electricity after 
such equilibrium has been disturbed. 

State the uses of electricity in generating heat, light, 
and mechanical motion, and in favoring chemical action. 

Heat generated by electricity may be employed in porce- 
lain furnaces for baking — may be used to reduce metal ores 
to metals, as in obtaining aluminum — may be used to melt re- 
fractory metals like platinum — to soften surface-hardened 
metals at certain points — to weld metals — for cooking and 
heating purposes, etc. 

Light obtained by electric action may be of great intensity 
and may be applied to examination of cavities of the body, 
as in the use of the endoscope, etc. 

Mechanical motion may be brought about by the action of 
an electric motor whereby motion is transmitted to various 
instruments such as the dental engines, lathe, etc. 

By electric force we may bring about the union of many 
simple bodies to form complex or compound ones; as hydro- 
gen and chlorine may be caused to unite by an electric spark; 
or we may obtain the separation of substances formerly 



PHYSICS, CHEMIST BY AND METALLURGY. 273 

united, as by the electrolysis of gold chloride solution, yield- 
ing chlorine gas and gold. 

Describe a method by which electricity produces (a) 
heat, (b) light, (c) mechanical energy. Show that elec= 
tricity favors chemical action. 

(a) Pass a strong current along a poor conducting metallic 
wire, as platinum, bent in a loop, and from the impedence 
or resistance the current encounters, the metal is heated, 
forming an instrument for cauterizing. 

(b) Enclose a film of carbon in an exhausted glass globe 
and, in the absence of air, the carbon glows from incan- 
descence due to the heat arising from resistance to the pass- 
age of the current. 

(c) Pass the electric current through a coil of insulated wire 
that surrounds the bar of soft iron and the bar becoming 
magnetic draws to it an elastic hammer which it releases, to 
spring back and strike a bell, when the current ceases to 
flow through the coil of wire. 

Pass an electric spark into a mixture of hydrogen and 
oxygen gases; they combine with explosive violence to form 
water vapor. 

Describe a method of obtaining the specific gravity of 
(a) solids, (b) liquids, (c) gases. 

(a) To obtain specific gravity of solids divide the weight of 
the solid in air by the weight it loses when suspended and 
weighed in water. 

(b) To obtain specific gravity of liquids: Counterbalance 
an empty flask, then fill the flask with distilled water at 60° F., 
and find the weight of water the flask holds ; empty the flask 
and fill it with the liquid to be examined at 60° P. and find 
the weight of the liquid the flask holds; divide the weight 
of the liquid by the weight of water, the result being the 
specific gravity of the liquid. 

(c) To obtain specific gravity of gases exhaust a large glass 
ilask of air and counterbalance ; fill the flask with dry air at 

IS 



274 PHYSICS, CHEMISTRY AND METALLURGY. 

0° C, and at a pressure of 760 mm. as shown by the barometer, 
and find how much this bulk of air weighs — then exhaust the 
flask of air and fill with the gas to be examined at the same 
temperature and pressure and weight — divide the weight of 
the gas by the weight of the air: the result will be the specific 
gravity. 

Mention four compounds, giving the formula and molec- 
ular weight of each. 

Water, ILO. molecular weight 18. 
Carbon dioxide, CO,, molecular weight 44. 
Sulphuric acid, H 2 S0 4 , molecular weight 98. 
Nitric acid, UNO.,, molecular weight 63. 

Give the formula of carbolic acid. Mention an antidote. 

Carbolic acid. C e H s OH. 

Antidote, a soluble sulphate, as Epsom salt. 

Place the chemical formula after each of the following^ 
acids: Sulphuric, nitric, hydrochloric. 

Sulphuric acid, H 2 S0 4 . 
Nitric acid, HNO.,. 
Hydrochloric acd, HC1. 

Give the formula of acetic acid, oxalic acid. 

Acetic acid, IIC,H 3 2 ; Oxalic acid, H 2 C 2 4 . 

Give the common names of H.,0, HNO :1 , H 2 CO.„ and 
NO. 

TLO. water; UNO.,, nitric acid or aqua fortis; 1LCO,, car- 
bonic acid; N 2 0, nitrous oxide or laughing gas. 

Write the equation showing the reaction of sulphuric 
acid on common salt. State a general theory to this 
particular reaction. 

If two chemical compounds be brought in contact with each 
other under favorable conditions, should one or more elements 
of one of the compounds have an attraction or affinity for one 



PHYSICS, CHEMISTRY AND METALLURGY. 275 

or more elements of the other compound, these elements will 
leave their original compounds, and, uniting, form new bodies. 
H 2 S0 4 + NaCl = NaHS0 4 + HC1 : or H 2 S0 4 + 2NaCl = 
Na 2 S0 4 + 2HC1. 

Give the chemical equation for the formation of water 
from its elements. 

2H 2 + 2 4-heat = 2H 2 0. 

Give the formula and properties of (a) hydrochloric 
acid, (b) sulphuric acid, (c) sulphurous acid, (d) phos- 
phoric acid. 

(a) Hydrochloric acid (HC1) is a colorless gas, has a sharp 
penetrating odor, and is very irritating when inhaled. It is 
neither combustible nor a supporter of combustion, and has 
great solubility in water. Although hydrochloric acid is a 
gas this name is also employed for its solution in water. The 
hydrochloric acid of the U. S. P. is an acid containing 31.!)' < 
•of HC1, and is a colorless, fuming liquid. 

(b) Sulphuric acid (H 2 S0 4 ). Pure acid has a specific 
gravity of 1.848; it is a colorless liquid, of oily consistency, 
and has a great tendency to combine with water, absorbing it 
readily from atmospheric air. Upon mixing sulphuric acid 
and water, heat is generated. It also has the property of de- 
stroying and blackening organic matter, and is corrosive and 
caustic. The sulphuric acid of the U. S. P. should contain 
not less than 92.5% of H 2 S0 4 . 

(c) Sulphurous acid (II 2 SO :! ) is a colorless acid liquid 
which has the odor as well as the disinfecting and bleaching 
properties of dioxide of sulphur; it is completely volatilized 
by heat. The acid is easily oxidized by air to form sulphuric 
acid. 

(d) Phosphoric acid (H.,P0 4 ) is a colorless, odorless, 
strongly acid liquid, which on heating loses water, and finally 
is volatilized at a low red heat. 

Place the chemical formula after each of the follow* 
ing compounds: Hydrogen sulphide, potassium iodide, 



276 PHYSICS, CHEMISTRY AND METALLURGY. 

calcium sulphite, magnesium carbonate, and mercuric 
chloride. 

Hydrogen sulphide, H 2 S ; potassium iodide, KI ; calcium 
sulphite, CaS0 3 ; magnesium carbonate, MgCO ;! ; mercuric 
chloride, HgCl 2 . 

Place after each of the following compounds its chem- 
ical formula: Silver chloride, zinc sulphate, calcium oxide. 

Silver chloride AgCl, zinc sulphate ZnS0 4 , calcium oxide 
CaO. 

Indicate by an equation the reaction of zinc with hydro- 
chloric acid. 

Zn 2 + 411 CI = 2ZnCl 2 + 2H 2 . 

What chemical changes result from the addition of 
hydrochloric acid to silver nitrate? Answer by giving 
the equation. 

■ AgNO s + HC1 = AgCl + HN0 3 . 

Write the chemical formulae for sodium chloride, fer- 
rous sulphate. 

Sodium Chloride NaCl, ferrous sulphate FeS0 4 . 

Complete the following equations: CuO + H 2 S0 4 ; Zn -f- 
2HCI; AgN0 3 + NaCI. 

CuO + II 2 S0 4 = CuS0 4 + H 2 0. 
Zn + 2HCl = ZnCl,4-H 2 . 
AgNO g -f NaCl = AgCl + NaN0 3 . 

Write the formula for ammonium hydrate and potas- 
sium nitrate. 

Ammonium hydrate NII 4 OH, potassium nitrate KN0 3 . 

Give common names for zinc sulphate, copper sulphate, 
aluminum oxide. 

Zinc sulphate — \vhite vitriol. 

Copper -sulphate — blue stone, or blue vitriol. 

Aluminum oxide — alumina or corundum. 



PHYSICS, CHEMISTRY AND METALLURGY. 211 

What is understood by H 2 S0 4 ? 

Twice the atomic weight of hydrogen in chemical combin- 
ation with once the atomic weight of sulphur in chemical com- 
bination with four times the atomic weight of oxygen, form- 
ing one molecule of sulphuric acid, representing 98 parts by 
weight of sulphuric acid. 

What does H 2 2 represent? 

One molecule or 34 parts by weight of pure hydrogen 
peroxide. 

Mention three acids used in medicine. Give the for- 
mula for each. 

Acetic acid, HC„H 3 2 . 
Sulphuric acid, H 2 S0 4 . 
Hydrochloric acid, HC1. 

State the law of Avogadro and explain its relation to 
modern chemistry. 

Law of Avogadro : Under like conditions of temperature 
and pressure, equal volumes of all gases contain the same 
number of molecules. 

By this law we find gaseous molecules of all kinds to be 
equal in size so that by weighing equal volumes of a gas and 
of hydrogen, when subjected to the same temperature and 
pressure, we can at once establish the molecular weight, and 
after analysis, deduce the molecular formula of the gas ex- 
amined, and in the case of elementary gases determine the 
atomic weights. 

Differentiate between oxidizing agents and reducing 
agents. 

An oxidizing agent is a substance that readily parts with 
some or all of the oxygen it contains, giving it up to combine 
with other substances — this action occurring in most instances, 
under the influence of heat. Thus potassium nitrate if heated 
with lead, copper, etc., yields oxygen to those metals form- 
ing metallic oxides and itself changing to potassium nitrite. 



278 PHYSICS, CHEMISTRY AND METALLURGY. 

Potassium chlorate and manganese dioxide are frequently 
used as oxidizing agents. 

A reducing agent is a substance tending to combine with 
oxygen, so that it removes oxygen f rom other bodies : Thus 
when a mixture of charcoal and oxide of lead are heated, 
the lead oxide is reduced to form metallic lead, the carbon 
taking the oxygen from lead oxide becomes carbon dioxide. 
Hydrogen passed over cupric oxide or ferric oxide when 
heated, acts as a reducing agent. 

Explain the chemical terms monad, diad, triad, etc. 
Give an example of each. 

A monad, if an element, would unite with hydrogen in 
the proportion of once its atomic or combining weight with 
once the atomic weight of hydrogen; or. the monad if vapor- 
ized, would unite in equal measured volume with hydrogen. 

Theoretically we state one atom of a monad combines with 
one atom of hydrogen. 

If the monad be a compound radical, like Oil, then the sum 
of the atomic weights of its constituents unite with once the 
atomic weight of hydrogen. 

If the monad be a metallic element, or an electro-positive 
compound radical, its valency is shown by its power of dis- 
placing its own volume of hydrogen from compounds, or its 
combining weight will displace the combining weight of 
hydrogen from compounds; or, we often fix its valency by its- 
combining with one equivalent of chlorine weighing 35.5. 

A diad atom or radical combines with, or takes the place 
of two hydrogen atoms. 

A triad combines with, or takes the place of three hydrogen 
atoms. 

Among monads we have hydrogen, chlorine, potassium. 

Among diads we have oxygen, sulphur, calcium. 

Among triads we find nitrogen, boron, gold. 

Name two or more elements which ignite on contact 
with water. 

Sodium, potassium. 



PHYSICS, CHEMISTRY AND METALLURGY . 279 

What are the principal differences between metallic 
and non-metallic elements? 

A metallic element is solid at ordinary temperatures, with 
few exceptions. It has considerable weight, and is more or 
less malleable, ductile, and tenacious. It is opaque to light 
and is a good conductor of heat and electricity. It has luster, 
is electro-positive and forms at least one base with oxygen. It 
displaces hydrogen from acids to form salts. Substances not 
possessing these characteristics are grouped as non-metals. 

By what principle do elements combine to form com- 
pounds? 

In obedience to the laws governing chemical affinity; those 
atoms or radicals in unlike electrical conditions uniting to 
form compounds. 

Give examples of analysis and synthesis. 

Heating mercuric oxide produces the metal mercury and 
the gas oxygen (analysis). 

Passing an electric spark through a mixture of equal 
volumes of hydrogen and chlorine produces hydrochloric 
acid (synthesis). 

Passing a galvanic current through water we have produced 
one volume of oxygen and two volumes of hydrogen (analysis) . 

Heating one volume of oxygen and two volumes of hydrogen 
they unite with explosion to form water (synthesis). 

Why are the salts of some metals called sulphides, sul- 
phites, and sulphates? 

Sulphides are binary compounds, one of the two elements 
present being sulphur. Sulphates and sulphites are ternary 
compounds, known as oxy-salts, containing sulphur, oxygen 
and a metal ; the sulphates contain a larger number of 
oxygen atoms in each molecule than the sulphites. 

What are the essential properties of an acid? 

(a) It always contains hydrogen, which is wholly or par- 
tially replaceable by metals to form salts. 



280 PHYSICS, CHEMISTRY AND METALLURGY. 

(b) It changes the color of many organic substances, litmus 
changing from blue to red. 

(c) It has (when soluble in water) an acid or sour taste. 

(d) It unites with and neutralizes a base to form a salt 
and water. 

(e) It corrodes tissues when concentrated. 

By what force do atoms unite to form compounds? 
Give an example. 

By the force of chemical affinity favored by the action 
of one or more physical forces. 

Example, H 2 +Cl 2 -f electric spark=2HCl. 

What is a chemical equation? 

It is a writing, or diagram, representing upon one side of 
an equality sign the formulae of substances separated by plus 
signs, that when in contact, exert chemical action upon each 
other, leading to their decomposition, and upon the other side 
of the equality sign are placed the formulae of the new bodies, 
separated from each other by plus signs, that result from this 
chemical action. 

How is molecular weight obtained? Give illustrations. 

Molecular weight is obtained by ascertaining the sum of 
the atomic weights, or multiples of the atomic weights, of the 
constituents of the molecules; or, by taking twice the density 
of a compound compared with hydrogen when both are in a 
gaseous state. 

Molecular weight of H 2 0=2+16 or 18. 

Vapor density of H 2 0=9, then 9X2=18. 

Molecular weight of H 2 S0 4 =2+32+64 or 98; or, vapor 
density of H,S0 4 is 49, then 49X2=98. 

What is meant by chemical reaction? 

Chemical reaction represents by formula the re-arrange- 
ment of atoms and radicals after, through chemical action, 
they have been separated from their former union. 



PHYSICS, CHEMISTRY AND METALLURGY. 281 

What is the difference between two acids composed of 
the same elements, the name of the one ending in " ous " 
and that of the other in " ic "? Illustrate by giving name 
and formula. 

The acid that is most stable in composition, or of most 
importance, or is of greatest use, or from which salts of great 
importance are derived has its name terminating in "ic." 

The acid whose name terminates in "ous" contains a less 
number of oxygen atoms in each molecule than the acid 
ending in "ic." 

Examples, sulphuric acid H 2 S0 4 , nitric acid HN0 8 . 

Examples, sulphurous acid H,S0 3 , nitrous acid HN0 2 . 

Distinguish between an element and a compound. 
Give an example of each. 

An element is a substance, the molecules composing which, 
contain the same kind of atoms ; for example, copper, gold. 

A compound is a substance, the molecules composing it be- 
ing formed of different kinds of atoms, e. g. water, alcohol. 
Upon an element no force exerted will produce any other 
kind of matter than that originally present. 

A compound may, by the exertion of certain forces, be de- 
composed, yielding different kinds of matter than the orig- 
inal substance. 

Describe the chemical process by which minerals are 
converted into animal foods. 

Mineral substances in the soil are dissolved in water, which 
often contains carbon dioxide or alkaline silicates, thus con- 
verting such mineral substances into soluble alkaline, or 
double salts. The rootlets of plants absorb such mineral 
material when in solution, and store it up in the plant, after 
the mineral substance undergoes chemical change into or- 
ganic salts, as tartrates, citrates, acetates, etc., of the metal 
originally present in the mineral. The animal eating such 
plants then appropriates these organic salts after effecting 



282 PHYSICS, CHEMISTRY AND METALLURGY. 

their change, in the animal body, into snch salts as carbon- 
ates, phosphates, sulphates, etc. 

Give an example of (a) a physical change, (b) a chem- 
ical change, (c) a mixture, (d) a chemical compound. 

(a) The dissolving of salt in water, the melting of ice. 

(b) Union of silver with nitric acid to form silver nitrate; 
union of oxygen and hydrogen to form water. 

(c) Iron tilings mixed with sulphur; sand mixed with sugar. 

(d) Apply heat to iron filings when they unite chemically 
to form ferrous sulphide which exhibits different properties 
than either iron or sulphur when alone. 

Classify the following acids, bases or salts: (a) lime, 
(b) vinegar, (c) cream of tartar, (d) baking soda, (e) 
ammonia. 



Acid* 


Bases 


Sails 


Vinegar 


Lime 


Cream of tartar 




Ammonia 


Baking soda 



Define negative elements, positive elements. Men- 
tion the conditions under which negative and positive 
elements act on each other. Illustrate this action. 

A negative element is one which if freed from a compound 
by electrolysis would be found at the positive electrode. A 
negative element is one that combines with oxygen to form 
an acidulous compound. A negative element is a metalloid. 

A positive element is one which when freed from a com- 
pound by electrolysis appears at the negative electrode. A 
positve element is one that combines with oxygen to form a 
basic or neutral oxide. A positive element is a metal. 

Negative and positive elements combine when in nascent or 
atomic conditions, when in contact, and when the exertion of 
a physical force favors the union. 

How is matter classified? 

Simple and compound. Mineral, animal and vegetable. 
Organic, inorganic and organized. 



PHYSICS, CHEMISTRY AND METALLURGY. 283 

Atom, molecule and mass. 

Solid, liquid, gaseous, and radiant. 

In what condition are elements generally found in 
nature? Mention two exceptions. 

In combination with other elements forming compounds. 
Exceptions, carbon as diamond and oxygen mixed with nitro- 
gen in atmospheric air; in these instances carbon and oxygen 
are in their elementary forms. 

Define atom, molecule. 

An atom is the smallest indivisible particle of elementary 
matter, not capable of self-existence but passing from one 
compound to another in chemical interchanges. 

(New). An atom is an aggregation of a definite number of 
corpuscles or electric units, oscillating as a whole; upon the 
number and rapidity of movement of these corpuscles, the 
chemical identity of the atom depends. 

A molecule is the smallest part of any substance that can 
exist alone and exhibit the properties of the substance. It 
is a cluster of two or more atoms bound together by chemi- 
cal affinity. 

What is meant by analysis? 

Analysis is the name given to the process of separating ele- 
ments from compounds or compounds from complex struc- 
tures, leading to the recognition of elements or compounds 
that exist in more complex bodies. Analysis is the process 
of determining the composition of a body by separating its 
constituents. 

What is synthesis? 

Synthesis is the name given to the process of producing 
substances by bringing about the union of their constituent 
elements, or simpler compounds. 

For what element is there the most extensive affinity? 

Oxygen. 



284 PHYSICS, CHEMISTRY AND METALLURGY. 

State how to obtain an atomic weight. 

The atomic weight equals 6.4 divided by the specific heat of 
the element. We may also obtain the atomic weight by not- 
ing in what weight the element, if it be a monad, will replace 
one part by weight of hydrogen in an existing compound. 

By obtaining its vapor density compared with hydrogen. 

Define electrolysis. Describe an experiment illustrat- 
ing it. 

Electrolysis consists of the separation of the constituents 
of a compound through the action of an electric current. 
Iodine may be separated from potassium by passing an elec- 
tric current through a solution of potassium iodide, when, if 
starch mucilage be present, the liberated iodine combines with 
it to form bluish-black iodide of starch. 

State the theory of valency. 

Valency expresses the numerical power for union by 
volume, which different elementary substances show, com- 
pared with one volume of hydrogen. Theoretically it indi- 
cates the number of hydrogen atoms required to unite with 
or to take the place of one atom of another element, or radical. 

Distinguish between alkali and alkaloid. 

An alkali is a soluble base. 

It is an oxide or hydrate of an alkaline metal. It is a 
mineral substance whose solutions turn red litmus blue. It 
neutralizes acids to form salts and water. It forms soaps 
with fats. When strongly heated it leaves a residue. 

An alkaloid is an active principle of an organic substance 
and is alkaline in reaction. It always contains nitrogen and, 
in addition, carbon, hydrogen and often oxygen. It is called 
an organic base. An alkaloid when heated burns with an 
odor of burning feathers, then forms a black char, and on 
continued heating entirely disappears. 

By what process are constituents of compounds ob- 
tained? Give an example. 

By electrolysis and by heat. Separation of oxygen and 



PHYSICS, CHEMISTRY AND METALLURGY. 285 

hydrogen from water by electrolysis. Separation of oxygen 
and mercury from mercuric oxide by heat. 

Explain the use of atomic weights. 

Atomic weights are used as combining weights, giving us 
the proportion by weight of one element required to unite 
with a definite weight of a second element in forming a 
compound. 

Distinguish between a simple molecule and a compound 
molecule. 

A simple molecule is composed of atoms of the same kind. 
A mass of such molecules is known as an element. 

A compound molecule is composed of atoms of different 
kinds. Such molecules in mass are spoken of as compounds. 

Mention two ways in which elements occur in nature, 
and give examples of three elements occurring in both 
these ways. 

In uncombined state, as oxygen mixed with, but not in com- 
bination with nitrogen in air; as nitrogen found elementary 
in air; as carbon found elementary in diamonds, in graphite. 

In compounds or unions with other elements : As oxygen 
combined with metals occurring as oxides, as nitrogen found 
combined as salts called nitrates, in the soil ; as carbon exist- 
ing combined as carbonates united wth different metals, as 
in limestone. 

Explain the use of symbols and formulae. Give and 
translate five examples of each. 

A symbol is used to represent one atom of an elementary 
substance. 

A formula is a combination of symbols that represents one 
molecule of a substance. 

Examples of symbols: Oxygen, 0; hydrogen, II; sulphur, 
S ; nitrogen, N; chlorine, CI. 

Examples of formula2: Water, H 2 ; nitric acid, HN0 3 : 
sulphuric acid, ILS0 4 ; hydrochloric acid, HC1; ozone, O s . 



286 PHYSICS, CHEMISTRY AND METALLURGY. 

What is the difference between a mixture and a chem- 
ical compound? 

Mixtures are joined together by adhesion and cohesion, and 
can be separated by such physical means as heat, magnetism, 
solution, etc., and the constituents may be mixed in any pro- 
portion, and when mixed do not lose their characteristic prop- 
erties nor give rise to heat. A chemical compound is one 
joined through chemical force, differs in properties from 
those of its constituents, forms only on combining definite 
weights of constituents, and its production is accompanied 
by lieat. 

Mention a test by which organic compounds may be 
distinguished from inorganic compounds. 

On heating the substance, if it be organic, it first chars 
and then burns entirely away, leaving no residue; if it be 
inorganic, it does not char and although strongly heated 
leaves a residue, (except in the case of ammonia compounds, 
and water, which do not leave residues when heated). 

Define (a) monad, (b) diad; (c) give examples of each. 

(a) A monad is an clement or compound radical whose 
atom or radical has the power of replacing one atom of hydro- 
gen from a compound, or combining with one atom of hydro- 
gen ; examples; potassium, sodium, silver. 

(b) A diad is a substance whose atom or radical has the 
power of replacing two hydrogen atoms from a compound, or 
requires two hydrogen atoms with which to combine; ex- 
amples, oxygen, sulphur, calcium. 

Explain how it is that heat both oxidizes certain metals 
and de=oxidizes their oxides. 

Heat brings about the union of the oxygen of the air and 
certain base metals like copper, which when heated in air 
forms cupric oxide. An intense heat weakens chemical affin- 
ity, so that if a body desirous of combining with oxygen be 
heated with a metal oxide the oxygen leaves the metal to join 



PHYSICS, CHEMISTRY AND METALLURGY. 287 

the other substance; thus, cupric oxide heated with charcoai 
produces the metal copper and carbon monoxide and carbon- 
dioxide. 

Very high temperatures as exist in the sun prevent chemi- 
cal union of elements. 

Heat of low intensity may occasion combination with 
oxygen, as when barium monoxide changes to barium dioxide 
when heated in air ; and on raising the temperature this new 
compound again produces barium monoxide and oxygen. 

State and illustrate the law of multiple proportions. 

If two elements, "A" and "B, " enter into chemical com- 
bination with each other in more than one proportion the 
quantities of B which unite with a fixed quantity of A will 
bear a simple ratio to each other. Nitrogen and oxygen com- 
bine in five distinct proportions with each other : thus 28 parts 
by weight of nitrogen combines with 16, 32, 48, 64, and 80 
parts by weight of oxygen. Representing nitrogen by A we 
then find that to every seven (7) parts by weight of nitrogen 
there will unite 4, 8, 12, 16, or 20 parts of oxygen, which we 
represent by B. 

Define potential as applied to electro-chemistry. 

It refers to the stored charge of either negative or positive 
electricity held by the ion at the moment of its dissociation. 

Define chemical affinity and state how it differs from 
other forces. 

Chemical affinity is the attractive force which acts between 
atoms of matter. In its action it differs from the molecular 
or physical forces in acting upon atoms, in being accompanied 
in its action by heat, in producing new substances as a result 
of its action, and in acting inside the molecules of matter. 

Physical forces act outside the molecules. 

Both chemical affinity and physical forces act at inappre- 
ciable distances. 



288 PHYSICS, CHEMISTRY AND METALLURGY. 

Molar forces, like gravitation, etc., act upon masses and 
often when they are widely separated. 

Differentiate, from a chemical standpoint, animal life 
and vegetable life. 

Chemical changes that occur in plants are more those of 
synthesis, while in animals analytical changes predominate. 

The plant takes as food simple substances or compounds, 
and constructs them into complex bodies. 

The animal takes as food complex bodies yielded by plants 
and decomposes them into simpler bodies, transposing then- 
potential energy into kinetic. 

The products of vegetable chemical activity are frequently 
crystalline and may often be artificially produced. 

The products of animal chemical activity are usually fibrous 
or cellular, and cannot be manufactured. 

Define a chemical compound. Mention three chemical 
compounds. 

A chemical compound is a substance whose molecules are 
composed of different kinds of atoms. Examples: Water 
H 2 0, alcohol C 2 H-OH, ammonia NH 3 . 

What is analytical chemistry? State the object of (a) 
qualitative analysis, (b) quantitative analysis. . 

It is that department of chemistry that has to do with the 
separation of compounds or complex structures into simpler 
ones, and the recognition and estimation of these simpler sub- 
stances. 

(a) Qualitative analysis seeks to ascertain the different 
kinds of elements composing compounds or compounds pre- 
sent in complex structures. 

(b) Quantitative analysis seeks to determine the amount of 
elements present in a definite quantity of a compound or the 
amount of simple compounds existing in a given quantity of 
a complex structure. 



PHYSICS, CHEMISTRY AND METALLURGY. 289 

Differentiate organic chemistry and inorganic chem« 
istry. 

Organic chemistry is the chemistry of the hydrocarbons 
and their derivatives. The number of elements in organic 
compounds is usually small ; but the number of atoms in the 
molecule is frequently large. 

Organic chemistry treats of substances composing vegetable 
and animal structures and the products of animals and plants. 

Organic chemistry treats largely of compound radicals. 

Inorganic chemistry is the chemistry of mineral substances: 
is largely a study of elementary matter and their combinations. 

Number of atoms in a molecule is usually small. 

Mention four chief elements that enter into organic 
compounds. 

Carbon, hydrogen, oxygen, and nitrogen. 

State one of the reasons for regarding the atomic weight 
of oxygen as 16 instead of 8. 

Its density compared with hydrogen is 16, not 8. 

Explain the following terms: Slow combustion, com= 
bustible substances, supporter of combustion. 

Slow combustion refers to oxidation of a substance, the pro- 
cess extending over considerable time, and being unaccom- 
panied by evolution of light and with scarcely perceptible in- 
crease of temperature. 

A combustible substance is one which under proper condi- 
tions unites chemically with other bodies giving rise to heat 
and light. 

A supporter of combustion is a substance, like oxygen, in 
which a combustible substance will burn, undergoing rapid 
oxidation. 

Give two methods of obtaining hydrogen. 

(1) By the action of zinc on sulphuric acid. 

(2) By the electrolytic decomposition of water, and col- 
19 



290 PHYSICS, CHEMISTRY AND METALLURGY. 

lection of hydrogen in a tube placed over the negative 
electrode. 

Describe the preparation of hydrogen. 

Place zinc in dilute sulphuric acid and hydrogen gas will 
be evolved which may be collected in jars previously filled 
with water; while in the dilute acid, sulphate of zinc will 
be produced. 

(a) What is hydrogen? (b) State some of its chem= 
ical relations. 

Hydrogen is a colorless, odorless, tasteless gas, the lightest 
of the well-known elements, its symbol is H. atomic weight 1. 
valency 1, condition electro-positive. 

It combines with all non-metals and with a few of the 
weaker metals like arsenicum and stibium. 

Give two methods for obtaining oxygen. 

The oxides of the noble metals are decomposed at a low 
temperature; so, heat red oxide of mercury, obtaining oxy- 
gen gas. 

Potassium chlorate, KC10 ; , is decomposed by heat into 
potassium chloride. KC1 and oxygen gas. 

Mention three methods for obtaining oxygen. 

(1) Heat barium peroxide above a red temperature when 
barium monoxide and oxygen gas are produced. 

(2) Heat a mixture of potassium chlorate and manganese 
dioxide, when oxygen gas is evolved at a comparatively low 
temperature. 

(3) Pass a galvanic currenl through water and collect 
oxygen gas in a tube placed over the positive electrode ; such 
oxygen resulting from the decomposition of water. 

What is the compound of oxygen and another element 
called? 

An oxide. 



PHYSICS, CHEMISTRY AND METALLURGY. 291 

What is ozone? Name some of its properties. 

Ozone, 3 , is a blue, irritating, and irrespirable gas, heavier 
than air, readily soluble in ether, turpentine, etc. 

It occurs naturally, in very minute quantity, in pure a.ir, 
particularly near pine forests, the sea-shore, and where large 
films of water undergo rapid evaporation. 

It oxidizes substances more energetically than oxygen, act- 
ing upon substances like silver, that resist the action of ordi- 
nary oxygen. 

It bleaches, disinfects, and strongly oxidizes. 

How can it be determined that the composition of 
water is H.,0? 

. By passing an electric current through water, and by so de- 
composing it we obtain two volumes of hydrogen and one 
volume of oxygen weighing respectively 2 for hydrogen an.l 
16 for oxygen. (Analysis). 

By mixing two volumes of hydrogen, weighing, say 2 grains 
and one volume of oxygen, weighing, say, 16 grains, and pass- 
ing an electric spark through the mixture, the result will 
form 18 grains or two measured volumes of water vapor. 
( Synthesis.) 

Distinguish between oxygen and ozone. 

Oxygen is a colorless gas, no difficulty is experienced in 
inhaling it, its molecule contains two atoms. 

Ozone has a blue color, is so irritating when inhaled as to 
produce hemoptysis, when concentrated. Ozone is far more 
active in producing oxidation of substances than is oxygen ; 
its molecule contains three atoms. 

What influence has temperature on a mixture of hy= 
drogen and oxygen? 

A high temperature causes their chemical union to form 
vapor of water, such formation accompanied by explosive 
violence. 



292 PHYSICS, CHEMISTRY AND METALLURGY. 

How is hydrogen dioxide obtained and what is its for= 
mula? 

It is obtained by the decomposition of barium dioxide sus- 
pended in water on adding sulphuric acid, Ba0 2 -(-H 2 S0 4 = 
BaS0 4 +H 2 2 . The H„0 2 thus obtained is not pure, but con- 
tains a considerable quantity of water. Prom this aqueous 
solution we can obtain a 50% solution by evaporation at a 
temperature not exceeding 140° P. If this product is placed 
in vacuo over strong sulphuric acid, a nearly pure or lOO'/t 
syrup-like hydrogen dioxide results. 

State the use of H.O^. 

It is used as a disinfecting, bleaching and oxidizing agent. 

What chemical change occurs in the action of H.,0., as 
a germicide or antiseptic? 

ILOo, in contact with organic matter, particularly pus, is 
decomposed into water and nascent oxygen. The oxygen so 
freed destroys germs or renders the soil non-fertile. 

Explain the reaction of H.,0., on putrescent pulps. 

In contact with pus H 2 O s is decomposed into water and 
nascent oxygen and the oxygen then acts on morbific matter, 
oxidizing it into harmless substances. 

Name the elements of the chlorine group. Give brief 
and separate descriptions of their properties. 

Fluorine, chlorine, bromine, iodine. 

Fluorine: A yellow gas, heavier than air, most active of 
all chemical elements, monad in valency, electro-negative, al- 
ways existing combined as fluorides of metals, as calcium 
fluoride. 

Acts chemically upon water forming hydrofluoric acid and 
ozone. Very corrosive, has bleaching and disinfecting prop- 
erties, has marked affinity for hydrogen, silicon, etc. Does 
not combine chemically with oxygen. 

Chlorine : A green gas readily liquified, two and a half 
times the weight of air, is monad in valency, electro-negative, 
combines with most, elements, never found elementary, exists. 



PHYSICS, CHEMISTRY AND METALLURGY. 293 

universally in combination with sodium in mineral, animal 
and vegetable substances, is a strong bleaching agent, is dis- 
infectant, and indirectly, through its affinity for hydrogen, 
acts as an oxidizing agent. 

Unites with some of the metals with such vigor as to oc- 
casion true combustion, as with antimony, arsenic, etc. 

Less active in its chemical combinations than fluorine, is 
soluble in water, exerting a slight decomposing effect upon 
water. 

Bromine: A heavy red liquid, three times the weight of 
water, giving rise to orange-red fumes at all temperatures, 
is monad, electro-negative, less active chemically than F or 
CI. It bleaches, disinfects and indirectly oxidizes. It 
forms no oxides. It is used as a caustic, combines with 
most metals and some of the non-metallic elements, its binary 
metallic salts are nervous depressors. 

Iodine : Occurs as a blue-black, scale- like solid, five times 
the weight of water, volatile at all temperatures, color of 
vapor, violet, monad, electro-negative. 

It possesses the properties of the other members of this 
group, although it is less active; is slightly soluble in water, 
more soluble in alcohol and freely so in ether and chloroform. 

Describe a method of preparing chlorine. 

Heat hydrochloric acid and manganese dioxide and collect 
the heavy chlorine gas that is evolved by downward dis- 
placement in empty jars. 

4HC1 + Mn0 2 = MnCl 2 + 2H 2 + CL. 

How is muriatic acid prepared? Give the equation. 

By roasting a mixture of sodium chloride and sulphuric 
acid and passing the resulting gas, HC1, into water. Nad -(- 
H 2 S0 4 =NaHS0 4 +HCl. 

Give the symbol and the method of preparation of 
iodine. State the use of iodine in dentistry. 

Iodine, I, is prepared from any iodide by the action of a 
mixture of manganese dioxide and sulphuric acid. 

2KI+Mn0 2 +2H 2 S0 4 =K 2 S0 4 +MnS0 4 +2H 2 0+L. 



294 PHYSICS, CHEMISTRY AND METALLURGY. 

The tincture is a counter-irritant, astringent and antiseptic, 
in the latter office particularly useful in the last stages of 
putrefactive decomposition. In strong tincture, combined 
with tincture aconite, it is applied to the gums in chronic 
pericementitis as a counter-irritant. In diluted tincture it 
is applied as an antiseptic and astringent in cases of con- 
gestion of the gums and pyorrhea alveolaris. It is useful 
in removing green stain. 

State the three allotropic forms of carbon. 

Diamond, graphite, lampblack. 

Name some of the purer forms of carbon as found in 
nature. 

Diamond, graphite, and anthracite coal or fossil carbon, 
often containing as high as 92',; of carbon. 

What per cent, of CO. exists permanently in air? What 
per cent, of CO. is dangerous to life? 

Pour parts of C0 2 exist permanently in 10,000 parts of 
air, or .04%. More than 6 parts of CO, in 10,000 parts of 
air, if the C0 2 is accompanied by respiratory impurities, is 
dangerous to life. 

Air containing one-twelfth of its volume of pure C0 2 will 
produce suffocation. 

Mention three great natural sources of CO,. 

Respiration of animals, burning of carbonaceous matter, 
decomposition of carbonates by heat or chemical action, 
alcoholic fermentation. 

State the conditions in which carbon is found in nature. 

It is found elementary in graphite and diamond. 

Is found combined in many gaseous forms, as CO, ( '< > 2 , 
CH 4 , C 2 H 4 , etc.; and exists combined in minerals as car- 
bonates and bicarbonates. is found in the composition 
of all animal and vegetable structures and occurs in large 
deposits in the many kinds of coal. 



PHYSICS, CHEMISTRY AND METALLURGY. 295 

Give the physical and chemical properties of carbon in 
each of three modifications. 

Diamond, hardest of substances, crystallizing an modifica- 
tions of regular octahedra, density 3.5, possesses the strong- 
est of refracting power, disperses light, poor conductor of 
electricity and heat, its chemistry is that of almost pure carbon. 

Graphite occurs imbedded in rocks in steel-gray foliated 
masses, sometimes in hexagonal tablets, can be scratched with 
the finger nail, makes black mark on paper, density 2.2., con- 
ducts heat and electricity. 

Lampblack is a soft, amorphous powder obtained from the 
incomplete combustion of carbonaceous matter: it contains 
tarry matter, is impure and is used in making printer's ink 
and paint. 

In chemical properties, each form of carbon is electro-nega- 
tive, is indisposed to enter into chemical union directly, ex- 
cept with oxygen, sulphur and a few elements. Carbon has 
an atomdc weight of 12, is diad and tetrad in valency and 
is -a solid non-metallic element. 

How does N.,0 rank as a supporter of combustion and 
of respiration? 

N,0 supports combustion but not as well as pure oxygen. 
It supports combustion only through its decomposition by the 
heat of introduced articles, practically producing a mixture 
of two volumes of nitrogen and one of oxygen. 

It does not support respiration of animals. 

Describe the manufacture of N.,0. 

N.,0 is obtained by heating ammonium nitrate, that has 
been fused, at a temperature between 470° F. and 490° F. 
The vapor so produced is then passed through three jars 
containing water, ferrous sulphate solution, and potassium 
hydrate solution ; the gas is then liquified by pressure, in 
steel cvlinders, in which form it is sold. 



296 PHYSICS, CHEMISTRY AND METALLURGY. 

How many nitrogen acids are there? State the name 
and formula of each. 

Nitric acid, HN0 3 ; nitrous acid, UNO,; hypo-nitrous acid, 
HNO or possibly H 2 N 2 2 . 

Describe ammonia and give its chemical formula. 

Ammonia, NH.,, is a colorless gas, each molecule of which 
is composed of once the atomic weight of nitrogen in chemical 
combination with three times the atomic weight of hydrogen. 

It is the second lightest compound gas, has a pungent, irri- 
tating, irrespirable odor, burns feebly, has a strong acrid 
taste, is corrosive and is the strongest of basic substances 
called the volatile alkalies. It is very soluble in water form- 
ing with water a chemical compound known as ammonium 
hydrate. It combines with acids to form salts without dis- 
placing the hydrogen of the acids. 

Write the formula of ammonia. State how ammonia 
is formed in nature. 

Ammonia, NH :! . It is formed naturally as the result of 
decay of nitrogenous matter, of organic nature, in the pres- 
ence of moisture, due to bacterial action, and is given off 
to the air in vaporous forms or is deposited in soils com- 
bined, as nitrates, nitrites or chlorides of ammonium. 

State the physical and chemical properties of nitrogen. 

Nitrogen, symbol N, atomic weight 14, valency 1, 3, 5. 
Is electro-negative, combines with but few elementary sub- 
stances, is inert, but enters into the composition of many 
active bodies, as the alkaloids, the proteid foods, the volatile 
alkali, and explosives. It is capable of being liquified and 
solidified by cold and pressure, is without color, odor or 
taste, is slightly lighter than air, and is soluble in water to 
the extent of 2% by volume. It is neither combustible nor 
a supporter of combustion. 

Mention the principal constituents of atmospheric air 



PHYSICS, CHEMISTRY AND METALLURGY. 297 

and state the proportions in which these constituents are 
present. 

Volume Weight 

Oxygen 20.93 23 

Nitrogen 79.07 77 

Including about 1% of argon, water vapor .5 to 1%, carbon 
dioxide .04. 

Traces of ammonia and nitric acid. 

Mention some decompositions by which ammonia is 
generated. 

By beating equal weights of quick lime and ammonium 
chloride, ammonia gas will be produced. 

Ammonia gas is produced during the destructive distilla- 
tion of soft coal in illuminating gas manufacture. 

Ammonia gas forms during the putrefaction of nitrogenous 
organic matters. 

Describe a method by which the four chief constituents 
of atmospheric air may be determined. 

Pass a weighed quantity of air successively through tubes 
or bulbs containing : First tube, calcium chloride ; second tube, 
solution of caustic potash; third tube, copper heated to red- 
ness ; fourth tube, magnesium heated to redness. 

Water vapor will be retained in the first tube, the increase 
in weight of which will indicate the amount of water vapor 
in the quantity of air employed. 

Carbon dioxide will be retained in, and increase the weight 
of, the second tube. 

The quantity of oxygen from the air employed will be de- 
noted by the increase in weight of the third tube. 

Nitrogen combining with magnesium will indicate by the 
increase in weight its quantity in the air examined. 

(a) Name and briefly describe the two principal ele= 
ments of the atmosphere, (b) Are these elements free 
-or in chemical combination. 

(a) Oxygen and nitrogen. 



298 PHYSICS, CHEMISTRY AND METALLURGY. 

Oxygen : symbol 0, atomic weight 16, specific gravity 1.1056, 
valency 2. 

It is a colorless, odorless, tasteless ga.s. capable of being 
liquified and solidified by cold and pressure. It. is soluble to 
the extent of 3% in water, is electro-negative, forms chemical 
union with all well-known elements but fluorine. 

Exists in air, and is dissolved in water, in elementary form, 
and is found in chemical compounds of animal, vegetable 
and mineral kingdoms. Constitutes one-third of all matter 
of the earth, supports combustion and respiration, is not 
poisonous, but in concentrated form acts as a general stimu- 
lant; it presents one allotropic form known as ozone. May 
be obtained by strongly heating potassium chlorate. 

Nitrogen: symbol N, atomic weight 14, specific gravity 
.971, valency 1-3-5. 

It is a colorless, odorless, tasteless gas, capable of being 
liquified and solidified, less soluble in water than oxygen, is 
electro-negative and very inert chemically, but enters into 
the formation (in its atomic condition) of very active chemical 
substances, as ammonia, proteids. alkaloids, explosives, etc. 

Number of elements with which it combines is limited. 

Obtained by passing atmospheric air over copper heated to 
redness, which withdraws from the air its oxygen. 

(b) These two elements exist free or elementary, only 
being mechanically mixed to form air. 

Mention three acids commonly employed in dentistry 
and give the specific use of each. 

Sulphuric acid— Local application to root canals, used for 
refining gold, for cleaning plates, as a solvent. 

Nitric acid — Used for refining gold, dissolving metals, as 
an oxidizing agent. 

Glacial phosphoric acid — Its solutions are added to zinc- 
oxide in making oxy-phosphate of zinc cement. 

What is aqua regia and its principal property? 

Aqua regia is a mixture of water, nitrosyl chloride and 



PHYSICS, CHEMISTRY AND METALLURGY. 299 

chlorine gas, obtained by adding one to two parts strong nitric 
acid to four to five parts strong hydrochloric acid. 

It is a solvent for gold and platinum. It is also used 
medicinally. 

Mention four of the principal elements found in the 
human body. 

Oxygen, hydrogen, carbon and nitrogen. 

What proportion of the air is nitrogen? 

Nitrogen constitutes about four-fifths of atmospheric air. 

Name the constituent elements and properties of the 
atmosphere. 

Oxygen, nitrogen, argon, and a few recently discovered 
elements. The atmosphere has no color, odor, or taste: it 
is 14.4 times the weight of hydrogen ; can be liquified and 
solidified by cold and pressure ; it exerts a pressure at the 
sea level of 14.7 pounds per square inch ; it readily supports 
combustion from the oxygen that it contains. It is a me- 
chanical mixture, and as such its composition slightly varies. 

(a) Describe the chemical changes that occur in the 
process of bleaching, (b) Name two bleaching agents 
employed in dentistry. 

(a) Chlorine only bleaches in the presence of moisture, 
combining with the hydrogen of water to form HC1, and 
liberating nascent oxygen, which latter oxidizes and so de- 
stroys coloring matter. 

Peroxide of hydrogen in watery solution. 

(b) Chlorine, as in chlorine water or chlorinated lime. 
Peroxide of hydrogen in contact with organic coloring 

matter is decomposed into water and nascent oxygen, and 
this latter destroys coloring matter. 

Describe the occurrence of sulphur in nature. 

Sulphur is found near volcanoes mixed with soil; it also 
occurs as crystalline deposits in rock. It is found naturally 
combined with most metals forming metallic sulphides, as of 



300 PHYSICS, CHEMISTRY AND METALLURGY. 

lead, zinc, mercury, etc. ; also occurs in metallic sulphates, as 
of calcium sulphate, barium, sodium, magnesium ; it exists 
in water as alkaline sulphides, as sulphur dioxide and as 
sulphuric acid. 

It is present in combination in many animal fluids and 
tissues, as albumin, hair, horn, etc. It exists in many vege- 
table substances, particularly such as yield oils of great 
pungency, as mustard and horseradish. 

Mention with regard to sulphur, (a) atomic weight, 
(b) valency, (c) color, (d) odor, (e) taste, (f) solubility, 
(g) behavior when treated. 

(a) 32; (b) 2, 4, 6 ; (c) lemon-yellow; (d) none (but its 
dioxide has a characteristic odor) ; (e) none; (f) insoluble in 
water, slightly soluble in hot alcohol and in chloroform, 
freely soluble in carbon disulphide and in alkaline solutions; 
(g) melts at 115° C. Becomes viscid at 200° C. to 250° C, 
when it adheres to vessel when inverted, again becomes thin 
and liquid above 250° C, boils at 440° C. 

What is blue vitriol? Describe the manufacture of 
blue vitriol and state its properties. Mention the uses 
in dentistry of blue vitriol. 

Blue vitriol is cupric sulphate CuS0 4 5II 2 0. It is manu- 
factured by dissolving copper in sulphuric acid ; is also ob- 
tained as a by-product in silver refining. It occurs as blue 
prismatic crystals, astringent, freely soluble in water. 

In dentistry it is used, dissolved in ammonia, as an astrin- 
gent and styptic. It is a source from which pure copper may 
be obtained. It is used in several forms of galvanic cells. 

Give the name and properties of H.,S0 4 . Describe the 
manufacture of H.,S0 4 . 

H 2 S0 4 is sulphuric acid. It is a highly corrosive, strongly 
acid, heavy, oily-like liquid. It is known as one of the min- 
eral acids. It combines with water producing great elevation 
of temperature. It dissolves many metals; its specific grav- 
ity is 1.8. 



PHYSICS, CHEMISTRY AND METALLURGY. 301 

Sulphur or a sulphide is burned in air and the resulting 
S0 2 gas, together with nitric acid gas 'and steam, passed into 
a series of leaden-lined chambers. These three vaporous sub- 
stances combine to form sulphuric acid, which, first vapor- 
ous, liquifies and falls in a rain to the floor of the chamber: 
from this it is removed and concentrated by evaporation. 

What is CaS0 4 and what are its uses in dentistry? 

OaS0 4 , containing water of constitution, is gypsum. On 
being roasted it parts with a portion of its water, forming 
plaster-of-paris. This latter substance is used for taking im- 
pressions or models of the interior of file mouth. Moulds 
of plaster are also used for the deposition, by electrolysis, 
of metal. 

How does plaster=of=paris differ chemically from quick= 
lime? 

Quick-lime is oxide of calcium, CaO. 

Plaster-of-paris is dehydrated sulphate of calcium. 3CaS0 4 . 
2H 2 0. (Bloxham). 

Describe the simplest test for sodium and potassium 
salts in solution. 

Concentrate the solution, clean a platinum wire and wetting- 
it in the solution, hold it in the inner Bunsen flame, when 
the outer flame will be colored yellow if sodium be present, 
and violet or pink if potassium be present. If both metals 
are present observe the yellow flame that sodium yields 
through blue glass, when the flame that potassium yields 
may be seen. 

Describe the preparation of plaster=of=paris. Explain 
the setting of plaster=of=paris. 

By roasting gypsum at temperatures between 300° P and 
400° F., it loses about two-thirds of its water of constitution, 
and is then powdered. In the setting of plaster the water 
with which it is mixed unites with the plaster-of-paris to 
give a substance containing slightly less water of constitu- 
tion than gypsnm before being roasted. 



302 PHYSICS, CHEMISTRY AND METALLURGY. 

Name the chemical constituents of saliva. 

Water 994. 10 

Solids 

Ptyalin 1.41 

Epithelium and proteids (including serum, albumin, 

globulin, mucin, etc. ) 2. 13 

Fat 0.07 

Salts: 

Potassium Sulpho-t'yanate, 

Sodium Phosphate, 

Calcium Phosphate, „ „q 

Magnesium Phosphate, 

Sodium Chloride, 

Potassium Chloride. J 



1000. 

State the salts that enter into the formation of human 
bone. 

Calcium phosphate, sodium chloride, magnesium phosphate, 
calcium thioride, calcium carbonate. 

What is the difference between assay and analysis? 

An assay is a process for determining the proportion by 
weight of oiie or several substances in a complex body, as, 
for instance, the amount of silver in a silver ore. or the 
amount of morphine in a specimen of opium. 

Analysis is used for determining the proportion by weight 
of all substances in a compound, whether metallic or non- 
metallic in character. 

Give an antidote for sugar of lead. 

Antidote for sugar of lead: A soluble sulphate, as sul- 
phate of magnesium. 

Give the properties of phosphoric acid and describe the 
official process of making it. 

Ortho-phosphoric acid. ll.,P0 4 . 

It is a colorless, odorless, strongly acid liquid, is tri-basic, 



PHYSICS, CHEMISTRY AND METALLURGY. 303 

forming three classes of salts. It does not coagulate albumin, 
it yields precipitates with most metallic salts in solution. 

It is decomposed by heat, parting with one or two mole- 
cules of water formerly held in combination. In its purest 
form, it is a crystalline solid. 

It is manufactured by boiling amorphous phosphorus in 
nitric acid, and when the phosphorus has entirely dissolved, 
the liquid is concentrated in platinum vessels until all of 
the nitric acid passes off, then water is added and the liquid 
placed over strong sulphuric acid under a bell jar, when 
all water evaporating, hard transparent crystals of ortho- 
phosphoric acid remain. 

This acid dissolved in water forms strong liquid phosphoric 
acid of 85% strength. 

Dilute phosphoric acid consists of lOOcc. of 85% acid and 
750cc. of water, and contains \0 f 7, of absolute phosphoric 
acid. 

Differentiate glacial phosphoric acid and common phos= 
phoric acid, and state in what respect the action of the 
former on the animal system differs from the latter. 

Glacial phosphoric acid has the composition P 2 0-, 
H 2 0=2HPO,. 

Ortho-phosphoric acid (or common phosphoric acid) has 
the composition P.O.,, 3H.,0=2H 3 P0 4 . 

Glacial phosphoric acid is usually sold in sticks, resembling 
caustic potash, but more glass-like in appearance. 

Ortho-phosphoric acid of 85% strength is dispensed in 
liquid form. 

Glacial phosphoric acid is poisonous, coagulates albumen, 
does not give a precipitate with magnesium sulphate, am- 
monium hydrate and ammonium chloride. 

Ortho-phosphoric acid is comparatively harmless, does not 
coagulate albumen, and forms a precipitate with magnesium 
sulphate, ammonium hydrate and ammonium chloride. 

What chemical product of bacteria is present in dental 



304 PHYSICS, CHEMISTRY AND METALLURGY. 

caries? (a) Does this product act on the mineral salts 
of the teeth? (b) If so, how? 

Lactic acid, (a) Yes. (b) By forming soluble salts at- 
tended by loss of tooth structure through solution. 

From what is lactic acid obtained? Describe a process 
of obtaining lactic acid and state its use in dentistry. 

It is obtained from sour milk and many other organic sub- 
stances. It is manufactured by allowing fermentation of a 
mixture of 8 parts cane sugar. 50 parts water, 1 part cheese, 
3 parts chalk, to continue for several weeks; this results in 
the formation of calcium lactate, and this is decomposed on 
the addition of sulphuric acid and alcohol, when the liquid, 
decanted, and allowed to stand, loses its alcohol through 
evaporation, leaving pure lactic acid as a colorless, strongly 
acid liquid. Its use in dentistry rests largely upon its power 
lo dissolve calcium phosphate and carbonate, and thus to 
decalcify teeth. 

Name four organic acids. 

Lactic acid, acetic acid, oxalic acid, butyric acid. 

State the composition and properties of oxalic acid. 
Describe the manufacture of oxalic acid, and mention an 
antidote for oxalic acid poisoning. 

Oxalic acid II 2 C 2 4 , occurs as colorless, transparent crys- 
tals, soluble in water, odorless, very acid, and highly poisonous. 

It is manufactured by making a paste of caustic potash, 
caustic soda and sawdust, and heating this for several hours 
on iron plates; then boiling the resultant with lime and water, 
then decomposing the calcium oxalate so formed by adding 
sulphuric acid, filtering and allowing the liquid to evaporate, 
when oxalic acid crystallizes. 

An antidote for oxalic acid poisoning is chalk or a soluble 
salt of calcium. 

What is fermentation? 

Fermentation is the decomposition of non-nitrogenous or- 



PHYSICS, CHEMISTRY AND METALLURGY. 305 

ganic substances produced through the agency of nitrogenous 
bodies called ferments. 

What are alkaloids? Name three. 

Alkaloids are active principles of organic substances. They 
all contain nitrogen, and are alkaline in reaction. They are 
called organic bases. Morphine, strychnine and quinine are 
three alkaloids. 

What is the source of tartaric acid? Give its use in 
medicine. 

It is the acid of the grape, occurring as acid tartrate of 
potassium, and when grape juice undergoes fermentation, 
this salt being insoluble, forms hard concretions, known as 
argols, deposited in the casks. 

From this substance tartaric acid is manufactured by add- 
ing to it lime forming calcium tartrate, and then adding sul- 
phuric acid, filtering and crystallizing tartaric acid from the 
liquid. In medicine it is used to lower cardiac action and to 
give acidity to the urine. 

Give the manufacture of chloroform. 

Chloroform is obtained by distilling a mixture of bleach- 
ing powder, water, lime and alcohol, and is purified by add- 
ing sulphuric acid, decanting, neutralizing with soda and re- 
distilling with quicklime. 

Mention (a) two disinfectants; (b) two antiseptics. 
Give an example of the use of each. 

S0 2 , sulphur dioxide and H 2 2 , hydrogen peroxide are two 
disinfectants. Sulphur burned in a room produces S0 2 . 
which destroys germs. Hydrogen peroxide in official solu- 
tions is added to collections of pus, when by direct oxidation, 
it destroys the germs present. 

Bichloride of mercury and boric acid are two antiseptics. 

The site of an operation, bathed by a solution of one part of 

bichloride of mercury in 2000 parts of water, renders the field 

of the operation non-fertile for development of germs. Boric 

20 



306 PHYSICS, CHEMISTRY AND METALLURGY. 

acid in 3% watery solution applied to the eye prevents the 
development of germ life. 

(a) Give a brief description of the chemical properties of 
alcohol, (b) Name its two principal forms, (c) How 
and from what is each derived? 

(a) Alcohol is a water in each molecule of which one hydro- 
gen atom has been replaced by an alcohol radical or a 
hydro-carbon radical. It is a neutral substance, inflammable, 
lighter than water, a marked solvent particularly for gums 
and resins, is hygroscopic, and Avhen burned yields a large 
amount of heat. 

(b) Methylic or wood alcohol. Ethylic or grain alcohol. 

(c) Wood alcohol is obtained by destructive distillation of 
wood in closed retorts, to the result of which sodium hydrate 
is added, and this mixture redistilled. 

Grain alcohol is obtained by distilling the results of fer- 
mentation of starchy or sugary liquids. 

State the formula of (a) common (ethylic) alcohol, (b) 
sulphuric ether, (c) acetic acid. 

(a) C 2 H,OH. (b) (C 2 H 5 ) 2 0. (c) HC 2 H 3 2 . 

Mention three alkaloids, giving their uses in dentistry. 

Morphin, as acetate, sulphate or muriate, is used in de- 
vitalizing mixtures and as an obtunding agent, and for 
temporary relief of odontalgia, is used internally for relief 
of facial neuralgia. 

When used as an obtunding agent it is usually combined 
with carbolic acid and oil of cloves. 

Cooain: its salts are used as local anesthetics and anodynes 
especially in alveolar pyorrhoea, extirpation of pulps of teeth 
and that of hypersensitive dentine; for extraction of teeth, 
in lotions for neuralgia and odontalgia. 

Atropin, as sulphate used locally as an obtunding agent, 
etc., and internally for neuralgia, etc. 



PHYSICS, CHEMISTRY AND METALLURGY. 307 

State the general, physical and chemical properties of 
an alkaloid. 

An alkaloid may be liquid but is usually solid. It is usu- 
ally of crystalline form, generally white in color, but slightly 
soluble in water, its salts being more soluble, the alkaloid 
is more soluble in alcohol and ether and most in chloroform. 
An alkaloid burns with an odor of burning feathers, then 
chars and finally burns entirely away, leaving no residue. 
Chemically, all alkaloids contain nitrogen along with carbon 
and hydrogen: the fixed alkaloids contain oxygen, while vola- 
tile alkaloids have no oxygen in their composition. They 
are all basic, though their salts may be neutral. They com- 
bine to form salts with acids without displacing the hydro- 
gen of the acid. They are tertiary and secondary amines, 
they all form precipitates with tannic acid, with fixed alka- 
lies, and with solutions of some metallic salts. 

Give the chemical constituents of (a) dentine, (b) 
enamel. State the properties of each constituent men- 
tioned. 

Organic substances and water 27.70 3.60 

Inorganic substances 72.30 96.40 

Inorganic substances included in 100 parts 
of ash : 

Calcic phosphate 71.32 93.35 

Calcic carbonate 1.61 4.80 

Calcic oxide ft.27 .86 

Calcic sulphate .09 .12 

Magnesic carbonate 7ft .78 

Iron oxide 10 .09 

traces 

of 
fluorine 

Inorganic strbstances give rigidity, form, hardness, and re- 
sistance to tooth structure; organic substances are largely in- 
strumental in the nutrition of the tooth including its blood 
and nerve supply. 

Define metallurgy. 

Metallurgy is the science that treats of the economical ex- 



308 PHYSICS, CHEMISTRY AND METALLURGY. 

traction of metals from their ores, and the application of 
metals to useful purposes. It includes a description of each 
metal. 

What is metal? 

A metal is an element, usually solid at ordinary tempera- 
tures, having considerable weight, being more or less malle- 
able, ductile and tenacious. It possesses lustre, is opaque to 
light and is a good conductor of heat and electricity. It is 
electro-positive, is capable of displacing hydrogen from acids 
to form salts, and will form at least one basic oxide with 
oxygen. 

Name three metals and give the symbol and atomic 
weight of each. 

Iron, Fe, 56. 
Gold, Au, 196.6. 
Aluminum, Al, 27. 

Mention three heavy metals. Give the symbol and 
atomic weight of each. 

Gold, Au, 196.6. 
Platinum, Pt, 197. 
Mercury, Hg, 200. 

Name some of the more malleable metals. 

Gold, silver, tin, copper, aluminum, platinum. 

What metal is the best conductor of heat? Of elec- 
tricity? 

Silver is the best conductor of both heat and electricity. 

Give the atomic weight and the symbol of gold, silver. 

Gold, Au ; atomic weight 196.6. Silver, Ag, 108. 

Compare gold, silver, copper and tin as to conductivity 
of heat. 

Best in conducting power for heat is silver, followed in 
order by copper, gold and tin. 



PHYSICS, CHEMISTRY AND METALLURGY. 309 

Mention the two groups into which metals are divided. 

Noble metals and base metals. 

Differentiate metallic element, metallic compound, and 
amalgam. 

A metallic element under the action of any force will no! 
give rise to any other substance than its original self. It is 
electro-positive and exhibits the properties known as metallic. 

A metallic compound is one usually consisting of a chemi- 
cal union of a metal with a non-metallic element or radical, 
and on its decomposition will yield two or more different 
substances than its original self, one of which substances will 
be of metallic character. 

An amalgam is a combination of one or more metals 
with mercury. 

Give the atomic weights and the symbols of (a) three 
heavy metals, (b) three light metals. 

(a) Osmium, Os, 198.5; iridium, Ir, 192.5; platinum, Pt. 
195.4. 

(b) Aluminum, Al, 27; magnesium, Mg, 24; potassium, 
K. 39. 

Give the name and atomic weights of each of the fol- 
lowing: Ca, Al, Ni, P, Pt. 

Ca, calcium, 40; Al, aluminum, 27; Ni, nickel, 58; P, phos- 
phorus. 31 ; Pt, platinum, 195.4. 

Give the comparative thermal and electrical conductiv- 
ity of gold, silver and tin. 

Conducting power for both heat and electricity is in order, 
first silver, second gold, third tin, of the metals mentioned. 

Mention some metals having (a) very low fusing points, 
(b) very high fusing points. 

Metals of low fusing point include mercury, sodium, potas- 
sium, tin, lead, (b) Metals of high fusing point include 
osmium, iridium, platinum, iron, nickel. 



310 PHYSICS, CHEMISTRY AND METALLURGY. 

State why an alloy becomes brittle when heated. 

When heated an alloy more readily undergoes oxidation 
than its component metals by themselves, and the oxides 
formed dissolve in the remaining metallic substances and by 
their presence diminish cohesion of the particles of tihe alloy 
by preventing perfect contact between those particles. 

State the requisite properties of metals used for dies. 
Hardness, non-contractility on cooling, fusibility at low 
temperatures, marked cobesiveness or absence of brittleness. 

State two processes of joining metals. 

Welding and soldering. 

Give the comparative thermal and electric conductivity 
of tin, silver, platinum and gold. 

Conducts heat Conducts electricity 

Tin 14.5 12.36 

Silver 100 100 

Platinum 8.4 18.80 

Gold 53.2 77.96 

Write the names of ten metals used in dentistry. State 
the proportion that this number of metals bears to the 
entire number of known metals. 

Gold, platinum, silver, zinc, tin, lead, mercury, iron, 
copper, bismuth. 

These represent about one-sixth the number of known me- 
tallic elements. 

Name three metals which are excellent conductors of 
electricity, heat and cold. Are these properties desirable 
or objectionable in metaNbase dentures? Give reasons. 

Silver, gold, copper. 

Such properties are objectionable because their change of 
volume endangers permanency of the denture and of the 
union of teeth to the plate; as conductors of heat and elec- 
tricity such metals cause irritation to sensitive parts, are apt 
to induce galvanic conditions in the mouth when filled teeth 



PHYSICS, CHEMISTRY AND METALLURGY. 311 

are also present, and affect the remaining healthy teeth from 
sudden changes of temperature. 

Explain the differences between annealing and temper= 
ing metals, and give an example of each process. 

Annealing a metal consists in heating it to a red heat 
and then (usually) letting it slowly cool. 

This process of annealing, or softening a metal, allows the 
molecules that have been forced into unnatural positions by 
hammering, etc., to again become normally related to each 
other. It restores lost malleability and ductility. 

Tempering a metal is usually performed by first heating 
the metal to redness and cooling instantly as by plunging in 
cold water — this makes the metal hard and brittle ; the metal 
is then slowly heated to a particular temperature, consider- 
ably below redness, and is then cooled quickly, the result be- 
ing to remove some but not all of the hardness occasioned 
by its initial heating. 

Example of annealing: — Gold after hammering becomes 
hard and brittle but when heated to redness and allowed to 
cool slowly in the air its softness and malleability is again 
restored. 

Example of tempering: — A dental instrument (lancet) 
after manufacture is first heated to cherry-red heat and then 
cooled by plunging in cold water; it may then be heated in 
the flame of a spirit lamp at some distance from its cutting 
edge and rotated while in the flame so as to heat all parts 
equally until the end of the instrument acquires a pale straw 
color due to the formation of a thin film of oxide (indicating 
a temperature of about 430° F.) when it is at once plunged 
into cold water. 

Place the chemical symbols after each of the following 
elements: Lead, tin, aluminum, antimony, nickel. 

Lead, Pb. ; tin, Sn. ; aluminum, Al. ; antimony, Sb. ; 
nickel, Ni. 



312 PHYSICS, CHEMISTRY AND METALLURGY. 

Place after each of the following metals its chemical 
symbol: Gold, platinum, silver, tin, and copper. 

Gold, Au. ; platinum, Pt. ; silver, Ag. ; tin, Sn. ; copper, Cu. 

Name five metals all of which can be manufactured into 
wire, sheet, or foil. 

Gold, silver, platinum, copper, aluminum. 

What constitutes the difference between a noble metal 
and a base metal? Give examples of each. 

A noble metal is one having so feeble an affinity for oxygen 
a.s to be incapable of rusting or tarnishing by oxidation in 
air when cold or heated, and whose oxide when formed can 
be decomposed by heat alone at temperatures not above a 
red heat. 

Among noble metals are gold, mercury, silver, platinum, 
iridium. 

A base metal is one which oxidizes in air at ordinary tem- 
peratures, or when heated, and whose oxide requires heating 
at a high temperature with the presence of a reducing agent 
in order to undergo decomposition. 

Among base metals we find lead, tin, zinc, iron, copper. 

Mention the only three metals which are attracted to 
the magnet and which can themselves become magnets. 

Iron, nickel and cobalt. 

Describe five metals and give the fusing point of each. 

Tin (fusing point, 442° F.) is a soft, silvery- white, malle- 
able metal, and is present in solder. It readily volatilizes 
when heated. 

Lead (fusing point, 617° P.) is a bluish, soft, malleable, 
ductile metal; is slightly tenacious, resists the action of sul- 
phuric acid, undergoes oxidation when melted. 

Zinc (fusing point, 779° F.) is a silver- white, highly crys- 
talline, brittle metal ; it is ductile and malleable when heated 
to certain temperatures. It is used in solder, and its oxide, 
forming when the metal is burned, enters into the composition 
of dental cements. 



PHYSICS, CHEMISTRY AND METALLURGY. 313 

Gold (fusing point, 2012° F.) is a yellow, soft, most malle- 
able and ductile metal, is insoluble in single acids, does not 
oxidize in air, and is markedly cohesive, -welding when cold. 

Copper (fusing point, 2192° F.) is a flesh-colored, or red- 
dish, malleable metal, harder than gold ; it is ductile, tenacious 
and tough ; is after silver the next best conductor of both 
heat and electricity, it enters into the formation of many im- 
portant alloys, like brass, bronze, german silver. 

What special properties of metals are most affected by 
alloying? 

Malleability and ductility are lessened, tenacity and hard- 
ness are increased, fusibility is lowered, sonorousness is in- 
creased. 

How does alloying affect the ductility of the noble 
metals? 

If noble metals are alloyed witfh base metals duetility is 
markedly lessened. 

A few noble metals like gold and platinum, or platinum 
and iridium are ductile when alloyed. The general rule is 
that the ductility of alloys is less than that of the constituenr 
metals. 

How does alloying a pure metal usually affect its (a) 
tenacity, (b) ductility, (c) malleability? 

(a) Tenacity is increased, (b) ductility is lessened, (c) 
malleability is lessened. 

What metals and alloys are used for dies and counter* 
dies? State for which each is best adapted. 

Dies Countei -dies 

Type metal of Pb 3 Sb 1 Sn 1 used with Lead 

Zinc used with Type metal 

Babbitt's metal Cu,Sb 2 Sn 8 or, 

Babbitt's metal Cu,Sb 2 Sn 24 used with Lead 

Haskell's metal Cu,Sb 2 Sn 4 used with Lead 5, tin 1 

Tin 5, antimony 1. 
Lead, tin, bismuth, antimony, cast iron. 



314 PHYSICS, CHEMISTRY AND METALLURGY. 

What conditions are essential for the perfect welding 
of metals, whether hot or cold? 

Perfect cleanliness. 

Freedom from oxidation, or deposits of metallic salts. 
Application of considerable compressing- force. 
Selection of the proper metals. 

Describe the difference between welding and soldering 
metals, (b) Is a new alloy formed of the metal and sol- 
der at the lines of union? 

Soldering is a process by which two or more pieces of metals 
are united by means of a fusible alloy termed a solder. It 
always requires the application of heat and does not require 
the exertion of a compressing' force, and in its performance 
it is customary to employ a flux, and, as a rule, the union 
effected by it is less firm than that brought about by welding. 

Often in soldering, different metals or alloys may be joined 
to each other. 

In welding, like metals are united through the exertion o!" 
considerable force without the use of a fusible alloy, and fre- 
quently without the application of heat, and with no necessity 
for use of a flux. 

(b) Yes. 

Why is a flux used in soldering metals? Name two 
substances so employed. 

To assist the flowing of solder and metal, and promote 
their intimate union by preventing oxidation, and dissolving, 
and removing oxides of metals, if formed between opposed 
surfaces. 

Among fluxes we have fused borax, a strong solution of 
zinc chloride. 

In making dental alio}', state the order of fusing the 
metals so that volatilization of the base metal may be 
prevented. 

Melt the highest fusing metal first. Protect its surface well 
with charcoal or borax. Add the other metals in the order 



PHYSICS, CHEMISTRY AND METALLURGY. 315 

of their fusing points, the lowest fusing metal being added 
last. 

Give the approximate composition of brass and of Ger- 
man silver. 

Nickel, 10 to 20 parts ~) 

Zinc, 20 to 30 parts V Form German Silver 
Copper, 50 to 60 parts 1 

Brass is an alloy of from 60 to 70 parts of copper, with 
30 to 40 parts of zinc. 

Define the term amalgam. 

An amalgam is an alloy of two or more metals, one of which 
is mercury. 

What are the advantages of annealing alloys for dental 
amalgam? Describe the process. 

To reduce brittleness, and again soften the alloy by remov- 
ing the hardness and molecular changes produced in making 
and in cutting the alloy. 

At times, to change the character of the alloy, and to secure 
a uniformity of it. The substances are heated and then al- 
lowed to slowly cool, the process being the inverse of temper- 
ing. Sometimes alloys are annealed by boiling in water. 

In uniting platinum to platinum, what would you use 
as a solder and why? 

Pure gold, for ordinary gold solders do not make a strong- 
joint, and for other reasons are not suitable, while pure gold 
readily alloys with platinum, melts below the fusing point, of 
platinum, gives a strong and permanent union, and acquires a 
color like platinum. 

What properties does platinum impart to its alloy with 
gold? 

Elasticity, gives greater strength, increased hardness, in- 
creases the ductility of platinum, lowers the fusing point of 
platinum, gives gold a paler color. 



316 PHYSICS, CHEMISTRY AND METALLURGY. 

Describe two different processes for fusing platinum. 

Place it in a cavity in asbestos or magnesium block, through 
which introduce jets of hydrogen and oxygen gases and light. 

Fuse it in electric furnaces between the terminals of the 
electric arc. 

Describe iridium, (a) With what other metal is it 
combined for dental use? (b) What are the advantages 
of these combinations? 

It is a white, lustrous, steel-like metal, slightly heavier than 
platinum, specific gravity, 22.4. It is not acted upon by 
air at ordinary temperatures. It is very hard and brittle 
when cold but becomes malleable at bright red heat. It re- 
quires the oxy-hydrogen flame for its fusion. Ordinary acids 
and aqua regia do not act upon it. 

(a) With platinum, to which it gives increased stiffness, 
hardness, and elasticity. 

(b) It also alloys with most metals giving hardness, rigid- 
ity and unalterable character to the alloy, as in certain dental 
instruments. 

What is arsenic? How is it obtained? Give some of 
its poisonous effects and name antidotes. 

Arsenic is arsenious anhydride. As-jO.,, known commercially 
as "White Arsenic." 

It is obtained from the flues of smelting works that reduce 
ores of many metals, particularly copper, nickel, zinc, and 
iron, in the ores of which the element arsenicum is generally 
found in combination with sulphur. 

The sweepings from such flues are subjected to sublimation 
when pure arsenic results as a sublimate. 

Arsenic is a gastro-intestinal irritant and a corrosive poison, 
and produces as characteristic symptoms a sweet, metallic, 
then nauseous taste, with intense burning pain extending from 
fauces to pit of the stomach, accompanied by vomiting and 
great thirst; then follow peculiar nervous symptoms, but 
delirium is absent. 



PHYSICS, CHEMISTRY AND METALLURGY. 317 

Chronic arsenical poisoning is shown by white, pasty com- 
plexion, following later by different forms of skin eruptions, 
and anesthetic areas, accompanied by progressive emaciation 
and anaemia and local edemas. 

Antidotes, freshly prepared hydrated sesqui-oxide of iron 
with magnesium. Dialized iron. 

Give a test for arsenic, antimony, gold. 

Reinch's Test for arsenic: — A thin piece of pure copper, 
having a bright metallic surface placed in a strongly acidified 
solution of arsenic becomes, upon heating tlhe solution, coated 
with a dark steel-gray deposit of arsenicum, which can be 
vaporized by the application of heat, when combining with 
air, forms as a sublimate octahedral crystals of the tri-oxide, 
which crystals dissolving in water give yellow precipitate 
with ammonio-nitrate of silver solutions ; or green precipitate 
wth ammonio-sulphate of copper solutions. 

Test for antimony : — Add hydrogen sulphide to an acidified 
solution of antimony, an orange-red precipitate of the sul- 
phide of antimony forms, which is soluble in solutions of alka- 
line sulphides. 

Test for gold : — Add hydrogen sulphide to a solution of 
gold ; brown auric sulphide is precipitated, which is soluble 
in yellow ammonium sulphide. 

Give a short description of gold and its dental uses. 

i 

It generally occurs native, always accompanied with silver. 
It is usually separated from soil, rocks, etc., by washing with 
water and amalgamating. It is obtained pure by parting the 
relatively pure gold from silver, copper and other metals by 
the use of acids, or by roasting the impure gold with potas- 
sium nitrate. It is yellow, specific gravity is 19.4, does not 
tarnish in air, nor oxidize directly. It ranks first in order 
of malleability and ductility, and fifth in tenacity. It is not 
as soft as lead but softer than copper. It welds when cold 
and is not dissolved by a single acid, except when heated 
with strong selenic acid. 



318 PHYSICS, CHEMISTRY AND METALLURGY. 

In dentistry it is used as foil for filling teeth, when pure for 
soldering platinum, alloyed with copper and silver and plati- 
num it is used as base for artificial dentures. Its elastic 
alloy with platinum is used for clasps and springs. 

What metals are used to alloy gold for clasps and 
springs? 

Platinum, silver, copper. 

Describe a method of (a) refining gold sweepings and 
filings, (b) separating gold from platinum. 

(a) First pass a magnet through the material to remove 
fragments of iron or steel, then melt in a graphite crucible 
with borax and nitre, then alloy the resultant with three times 
its* weight of silver and granulate this alloy, then boil these 
granulations in strong sulphuric acid, wash the resulting 
brown powder of gold, melt and cast into ingots. 

(b) Dissolve the alloy of gold and platinum in aqua regia, 
boil off as much acid as possible, dilute with distilled water, 
add ammonium chloride and alcohol, separate the precipitate 
of platinic-ammonic chloride by filtering, add to the filtrate 
ferrous sulphate solution, collect the brown precipitate of 
gold, wasli well with dilute hydrochloric acid, then witli 
water, dry and fuse with potassium carbonate and mould in 
an ingot. 

Gi\e two methods for refining gold. 

The roasting process : Impure gold is placed in a graphite 
crucible that has been well boraxed, its surface covered with 
potassium carbonate, it is heated to fusion, when a mixture 
of potassium nitrate and borax is added from time to time; 
after roasting for from one half hour to an hour and a half, 
base metals are oxidized and the resulting refined gold is 
poured into a mould. 

The wet method: Add approximately three times as much 
silver as we have of gold, fuse, cool, roll out and digest in 
nitric or sulphuric acid when heated, when gold, left un- 
dissolved, may be washed, fused and moulded. 



PHYSICS, CHEMISTRY AND METALLURGY. 319 

When gold and amalgam are used in approximal cavi- 
ties, which metal has the greater effect on the surround^ 
ing dentine? 

Gold. 

State the conditions that generate galvanic currents be= 
tween gold and amalgam filings, and the conditions under 
which such currents may be avoided. In case of galvanic 
currents, which metal, gold or amalgam, most affects the 
pulp? 

If gold and amalgam fillings be in contiguous teeth so as 
to be nearly in contact and there be an acid salivary secretion, 
galvanism may occur. Currents may be avoided by not 
bringing different metals close together, by neutralizing aciil 
saliva, and by selecting metals for the amalgam that are 
not widely different in their electric potential conditions 
from gold. 

Under the influence of galvanism gold affects the pulp most. 

Why do we find the quality of cohesiveness more 
marked in gold than in silver, copper and lead? 

Because gold metal is of a closer texture than the others, 
having a fern-like interlacing crystalline structure. It does 
not oxidize directly, and is probably not volatile. It has the 
power of welding when cold, and surface absorption of gases 
is readily removed by heating. 

What does the term " carat " signify? 

The term "carat" refers to the proportionate amount of 
pure gold in a gold alloy. Thus pure gold is said to be of 
24 carat, while 18-carat gold is composed of 18 parts of pure 
gold, and 6 parts of alloying metal. 

How do you find the carat? 

By using the following proportion example: As the weight 
of the alloyed mass is to the weight of gold it contains, so is 
24 to the standard sought. 

Or, make use of a touch-stone with its accompanying gold 



320 PHYSICS, CHEMISTRY AND METALLURGY. 

points of different degrees of purity, employing the cus- 
tomary acids. 

gold 6^) 
What carat would silver 2 I be? 

copper 1 J 
9:6::24:X; X=16. Ans. 

How do you reduce from higher to lower carat? 

Add to the gold of higher carat copper or silver or both, 
employing the following proportion example to obtain the 
required quantity of alloying metal. As the required carat 
is to the carat used, so is the weight used to the weight of the 
alloyed mass when reduced — when, the weight of the mass 
used subtracted from this will give the quantity of alloy to 
be added ; example ; Reduce 4oz. of 20-carat gold to 16-carat. 
16 : 20 : : 4 oz. : X = 5 oz. and 5 oz. — 4 oz. = 1 oz. alloy to be 
added. 

How do you raise gold from lower to higher carat? 

Add pure gold or a gold alloy richer in gold than the one 
to be raised. 

Rule: As the alloy in the required carat is to the alloy in 
the given carat so is the weight of the alloyed gold to the 
weight of the reduced alloy required, then the weight of the 
alloyed gold used, subtracted from this, gives the amount of 
pure gold to be added. 

Example : Reduce one dwt. of 16-carat gold to 18-carat ? 

First subtract both 16 and 18 from 24 to find the alloy in 
each carrat, then 6 :8 : :ldwt. :X = l l / 3 dwt., then IV3 dwt. 
—1 dwt=i/ 3 dwt. pure gold to add. 

Describe the process of alloying pure gold to make it 
suitable for 20=carat base plate, (b) State the propor- 
tion of each ingredient metal. 

Anneal a plumbago crucible while held inverted, then add 
the metals, on top of which place a small quantity of pow- 



PHYSICS, CHEMISTRY AND METALLURGY. 321 

dered charcoal, cover crucible with lid. Heat to a bright red 
heat and when melted stir with a red-hot iron rod, pouring 
as soon as possible after fusion. Grease the ingot mould 
and cast the metal, and then roll and hammer into sheets. 

(b) Pure gold, 20 dwt. ; copper, 2 dwt. ; silver, 1 dwt. ; 
platinum, 1 dwt. 

How would you distinguish a bar or a plate of tin from 
a metal similar in appearance? 

By its producing a creaking noise when bent, which is 
known as the "tin cry," and is due to the crystalline char- 
acter of the interior of the metal bar. 

Mention a solvent for gold and platinum. Give for* 
mula. 

Aqua Regia; 3HCl+HNO a =2H 2 0+NOCl+Cl 2 . 
Or, 3HC1+HN0 3 =2H 2 0+N0C1 2 +C1. 

State the chemical action that causes teeth clasped with 
gold to decay beneath the gold more quickly than those 
clasped with rubber. 

The gold clasp causes more attrition of tooth structure, fits 
less snugly allowing space for accumulation of material and 
its subsequent decomposition, with accompanying bacterial 
activity, while the rubber clasp slowly parting with sulphur, 
gives constantly germicidal and antiseptic protection from 
the sulphur dioxide that is formed. 

Explain how pure gold can be obtained from mixtures, 
alloys, and solutions containing gold and other substances. 

If material is liquid evaporate until dry, then, first re- 
move iron and steel by magnet; second, roast in well boraxed 
crucible with potassium nitrate and cast in ingot ; third, re- 
melt, fusing with three times its weight of silver, and granu- 
late this alloy ; fourth, boil these granulations in sulphuric 
acid, wash, then dissolve in aqua regia, precipitate platinum 
by adding ammonium chloride and alcohol, then to the liquid 
add ferrous sulphate, wash the resulting precipitate in hydro- 
21 



322 PHYSICS, CHEMISTRY AND METALLURGY. 

chloric acid, then in water, melt with potassium carbonate, 
and mould in greased ingot mould. 

Name several metals which readily impair or destroy 
the malleability and ductility of gold. 

Tin, lead, antimony, bismuth, arsenic. 

Give the physical properties of silver, and state its most 
important salt. Define the use in dentistry of silver. 

It is the whitest of metals, is brilliant and next to gold, 
most ductile and malleable. Is harder than gold, not so hard 
as copper. Fuses at 1904° F., has a specific gravity of 10.4. 
It is the best conductor of heat and electricity, volatile at full 
red heat, its vapor is blue. When fused it absorbs oxygen, 
which escapes as the metal cools, causing a roughened surface. 
Is not acted upon by pure air or moisture, but combines di- 
rectly with sulphur, phosphorus, or chlorine. 

Its most important salt is argentic nitrate AgN0 3 . 

Use of silver in dentistry: Alloyed with platinum forming 
dental-alloy, it is used for making base for artificial dentures 
and for crown and bridge work. Silver and tin are the 
two essential metals in all good dental amalgam alloys. An 
alloy of silver, copper and platinum is often used for base 
plate. Silver enteivs largely into the composition of dental 
solders. 

Describe a method of obtaining silver from one of its 
native ores. 

Amalgamation Process for silver sulphide reduction : 
Ore is crushed and roasted with common salt at dull red 
heat, when silver chloride and sodium sulphate result. 

This mixture is placed in barrels with water, scrap iron, and 
mercury, and the barrels rotated, when ferrous chloride and 
metallic silver result — the metal silver at once amalgamates 
with the mercury, and this amalgam, from its greater weight, 
sinking below the dross, is run off, squeezed in bags until 
solid, and distilled in iron retorts, when the mercury is re- 
covered and the silver, more or less impure, is left in the 



PHYSICS, CHEMISTRY AND METALLURGY. 323 

retort. This impure silver may then be mixed with lead and 
heated in a cupel furnace when silver of a fair degree of 
purity is obtained. 

Describe silver nitrate and give its chemical formula. 

Silver nitrate, formula AgN0 3 , crystallizes in colorless, 
right rhombic plates, soluble in its own weight of water, turns 
black on contact with organic matter, fuses readily unchanged 
and can be cast in moulds and in this form the impure salt is 
known as " Lunar Caustic." It is a corrosive and irritant 
poison, its antidote is common salt, or a soluble chloride. 
It is astringent, alterative, and caustic in action. 

Explain the chemical process for recovering pure silver 
from refuse amalgam. 

Heat the amalgam at red heat for some time to get rid of 
as much mercury as possible, then granulate and dissolve 
the metal in 50% strength nitric acid; decant from any in- 
soluble residue, and, to the clear liquid add solution of 
sodium chloride. Wash the resulting precipitate of silver 
chloride, place it in a clean beaker with twice its bulk of dis- 
tilled water, acidulate the liquid with sulphuric acid and in 
it place pure iron, as in the form of nails. Stir this mixture 
and when the precipitate becomes of a uniform gray color 
remove the iron, filter, wash the precipitate with well-diluted 
hydrochloric acid, and then with water. Dry the gray de- 
posit and fuse in a crucible that has been boraxed, with potas- 
sium carbonate, and when melted pour in an ingot mould. 

What salt of silver is used in dentistry? Give its for= 
mula. 

Silver nitrate. Its formida is AgN0 3 . 

Would you use silver in making plates? Why? 

No. From its softness and flexibility and its affinity for 
sulphur it is unfitted for plates when pure. When alloyed 
with platinum, it is used as a base for artificial dentures. It 
is generally alloyed with gold for use in dentistry. 



324 PHYSICS, CHEMISTRY AND METALLURGY. 

Mention the chief source of sodium. Give the principal 
reactions of sodium. 

Sodium occurs most abundantly as the chloride, existing 
as such in animal, vegetable and mineral structures. The 
metal sodium is generally obtained by distilling sodium car- 
bonate and charcoal in iron retorts. Sodium or its compounds, 
when heated in the inner Bunsen flame color the outer flame 
yellow. Its compounds are, in nearly all instances, soluble 
in water. 

(a) What is sodium silicate? (b) Mention the use of 
sodium silicate in dentistry. 

Sodium silicate, Na 2 SiO :! , is known as soluble glass and is 
obtained by strongly heating equal weights of sodium carbon- 
ate and sand, and dissolving the resultant in boiling water, 
this yielding a sohition of sodium silicate in water. 

(b) Is applied to bandages which, on drying, forms a per- 
fect cast of the part so that such stiffened bandage when cut 
and removed may be used as a splint, as in fracture of the 
jaw. 

Mention the properties and give the composition of 
cast=iron. 

Cast-iron is gray in color, brittle, melts at much lower 
temperature than wrought iron, contracts but little on cool- 
ing from fusion, is hard, has been used for dies for dental 
purposes. 

Its composition varies but it usually contains from 2 to 
4% of carbon, two-tenths to three per cent, of silicon, less 
than 2% of manganese and small quantities of sulphur and 
phosphorus. 

Name three salts of iron and place the chemical for- 
mula after each. 

Ferric chloride, Fe 2 Cl fi ; ferric sulphate, Fe 2 3S0 4 ; ferrous 
sulphate, FeS0 4 . 



PHYSICS, CHEMISTRY AND METALLURGY. 325 

Illustrate by symbols (formulae) the decomposition of 
(a) water by potassium, (b) sulphuric acid by iron. 

( a) 2H 2 + K 2 = 2KOH + H 2 . 

( b) 2H 2 S0 4 + Fe 2 = 2FeS0 4 + 2H 2 . 

What salt of iron is used as an antidote for arsenic 
poisoning? State how this salt may be rapidly prepared. 

Freshly prepared hydrated sesqui-oxide of iron with mag- 
nesium. This may be obtained by adding to any ferric salt 
of iron, like ferric sulphate in solution, calcined magnesia ; 
or by adding ammonia water to the solution of iron salt, 
quickly washing the precipitate with water, and squeezing it 
in a rag. 

By what simple treatment can a hard steel instrument 
be softened? How may softened steel be again hard- 
ened? 

Soften a hard steel instrument by heating to about a cherry 
red heat, and then allowing it to cool slowly. 

To harden steel heat it to redness and cool very quickly, 
as by plunging in cold water. 

Describe the method of tempering steel instruments. 

The instrument is first heated red hot, then plunged in 
water. It is then placed in a sand bath, leaving but a minute 
point of the instrument exposed to view ; heat is then 
gradually applied to the sand bath until the desired temper- 
ature, generally less than 500° F., indicated by the color that 
the instrument assumes, is reached, when the instrument is 
cooled quickly by immersing in water, acid, or oil. 

What do you know about mercury as a metal? 

It is the only metal liquid at ordinary temperatures, and 
is silver white. Specific gravity is 13.6, it does not tarnish 
in air. it dissolves all metals except iron, forming amalgams. 
Is soluble in acids. 



326 PHYSICS, CHEMISTRY AND METALLURGY. 

How are the impurities of mercury detected and how 
readily removed? 

A globule of pure mercury should be round. If it assumes 
an elongated shape or leaves a mark as it passes over a smooth 
white surface, or if it undergoes oxidation at ordinary tem- 
peratures in air, it is impure. To purify, distil mercury after 
covering its surface with iron filings ; or, add to mercury nitric 
acid and after contact for 24 hours, pour off the liquid and 
wavsh the mercury with water. 

Name some of the metals for which mercury possesses 
a great affinity. 

Tin, gold, silver, lead. zinc, copper. 

Mention the important ore of mercury and describe the 
process by which this metal is obtained from this ore. 

Cinnabar, HgS. 

This ore is heated in a kiln or furnace to which are con- 
nected large condensing chambers into which S0 2 gas and 
mercury vapor pass, the latter condensing. 

The metal so obtained needs purifying, to remove from it 
other metals usually contaminating it. 

Describe the properties of copper amalgam. Name 
some of its advantages and disadvantages. 

Obtained by direct union or, preferably, by electrolytic 
deposition. 

At first soft and plastic, after a few hours standing be- 
comes hard and crystalline, but may be again softened on 
heating. 

Though hard, it is malleable, can be polished, retains its 
lustre in air, but darkens on contact with sulphuretted hy- 
drogen. Does not expand on hai'dening. 

Advantages of copper amalgam: Such fillings retain good 
margins, are very hard and rigid, do not contract, but slightly 
expaud on setting and perfectly seal the cavity. 

Exerts beneficial effect on tooth structure. 



PHYSICS, CHEMISTRY AND METALLURGY. 327 

Disadvantages : Becomes bluish-black, undergoes surface 
disintegration. 

Name and describe two salts of mercury and give the 
formula of each. 

Calomel, or mild chloride of mercury, or mercurous chloride. 

A white amorphous powder sublimes without fusing, in- 
soluble in water and alcohol, used as a mild laxative in single 
dose of 10 grs., is not poisonous, formula Hg 2 Cl 2 , or HgCl. 

Corrosive sublimate, corrosive chloride of mercury, mer- 
curic chloride, bichloride of mercury : It is a white crystalline 
salt, soluble in water, alcohol and ether. It is a corrosive and 
highly poisonous substance, one twenty-fourth of a grain con- 
stituting a large single dose. It is extensively used as an 
antiseptic, when in solution in 2000 to 5000 parts of water. 
Used internally as an alterative. Its formula is HgCl 2 . 

State some of the general uses of mercury, (a) How 
may it act as an irritant poison? (b) What precautions 
should be observed for safety? 

Used in construction of thermometers, barometers, mano- 
meters, to measure the capacity of vessels, its amalgam with 
tin or silver used to make mirrors, used to amalgamate zincs 
of a battery, used finely divided as with chalk in medicine. 

(a) In finely divided state it may form soluble salts of 
poisonous nature, as mercuric chloride, from the action upon 
it of hydrochloric acid in gastric juice, or may produce or- 
ganic compounds of a soluble nature, or its vapor, constantly 
inhaled, may occasion a fomi of chronic poisoning from its 
ready conversion into mercurial compounds. 

(b) Obtain perfect cleanliness after its use, thorough ven- 
tilation in rooms in which its vapor escapes; if the slightest 
symptoms of ptyalism appear, stop any further ingestion of 
the substance and use astringent mouth washes; take inter- 
nally potassium iodide to facilitate the elimination of mercury 
from the system. 



328 PHYSICS, CHEMISTRY AND METALLURGY. 

State the conditions under which amalgam would be 
improved by washing. 

When there are present oily or fatty matters or dirt, 
from manipulation in the hand, or oxides or other metallic 
salts accidentally produced, washing amalgam in water, al- 
cohol, ether or chloroform has been recommended. 

Distinguish between the effects produced upon pulps by 
(a) inserting in the same cavity a compound filling of 
gold and amalgam, (b) filling approximal cavities, one 
with gold and the other with amalgam. Give reasons 
for the different effects. 

(a) If the compound filling be perfect, so that no fluid reaches 
its interior, no galvanic action takes place, and the tooth pulp 
is preserved. If on the other hand fluid penetrates the filling, 
galvanic action takes place leading to destruction of the pulp. 

(b) If the two fillings are in contact at any point galvanic 
action will oeciir, should the saliva become acid, and lead to 
a destruction of the pulp most marked in the tooth filled 
with gold. 

Describe the chemical process involved in the setting 
of amalgam. 

When an amalgam has heen produced the mercury at once 
begins to combine chemically with the metal or metals pres- 
ent. That this combination is a chemical one is shown by the 
occurrence of crystallization, the evolution of heat, and the 
extruding or forcing from the solidifying mass of the excess 
of mercury. 

What important properties should amalgams for filling 
cavities in teeth possess? 

A permanency of form, hard, dense and sufficiently tough 
to resist attrition, with edge strength and sharpness of edge, 
should offer perfect resistance to oral secretions and food, and 
be free from any metal that would favor the formation of 
injurious soluble salts, and should retain a good color. 



PHYSICS, CHEMISTRY AND METALLURGY. 329 

Describe (a) negative metallic fillings, (b) positive 
metallic fillings. 

A negative metallic filling would be one containing such 
metals as are weakest in their ordinary electro-positive con- 
ditions, while the positive metallic filling would be formed of 
the strongest electro-positive metals; thus, if we make a list 
of metals like Au, Pt, Pd, Sb, Hg, Ag, Cu, Bi, Pb, Ni, Fe, Sn, 
Cd, Zn, Al, such fillings containing metals from the last half 
would be positive fillings while those composed of metals 
selected from the first half would form negative fillings. 

By what chemical tests is the presence of lead recog= 
nized in solution? 

Hydrochloric acid gives a white precipitate of lead chloride 
soluble in boiling water. 

Hydrogen sulphide gives a black precipitate of lead sul- 
phide insoluble in ammonium sulphide. 

Sulphuric acid gives a white precipitate of lead sulphate. 

Potassic eliminate gives yellow lead eliminate. 

Alkaline carbonates give, with lead, white precipitates of 
basic carbonates. 

How is aluminum obtained? Give its symbol and 
atomic weight. 

By heating in reverberatory furnace, ten parts of double 
chloride of aluminum and sodium, five parts of double fluoride 
of aluminum and sodium, and two parts of metallic sodium ; 
or, by the electrolysis of a fused aluminum ore. 

Symbol is Al. Atomic weight is 27. 

(a) Describe the general properties of aluminum, (b) 
How is it employed in dentistry, (c) Why is its use 
limited? 

(a) It is almost as white as silver, is but two and one-half 
times the weight of water, is not acted upon by air, even where 
hydrogen sulphide is present, and so does not darken on ex- 
posure like silver, is extremely malleable and ductile, is very 



330 PHYSICS, CHEMISTRY AND METALLURGY. 

sonorous, is a good conductor of heat and electricity, melts at 
about 1150° F., is not acted upon by the vegetable acids, dis- 
solves in solutions of caustic soda or potash, and in hydro- 
chloric acid. 

(b) Is used as a base in connection with rubber or celluloid 
by which the teeth are attached — an alloy of copper and 
aluminum has been used as a base. Many dental appliances 
(trays, instruments, etc.) may be made of aluminum. 

(c) Its use is limited because of its ready solubility in 
alkaline solution, its great contraction after cooling, the diffi- 
culty of soldering it, the readiness with which it oxidizes 
when finely divided as in amalgams, and its attendant enor- 
mous swelling and marked chemical action. 

Why cannot amalgam of aluminum and mercury be 
employed to fill cavities in teeth? 

Aluminum amalgam is unsatisfactory from the leadiness 
with which oxidation takes place, its great expansion on set- 
ting, marked chemical action that occurs on amalgamating, 
liberation of much heat. 

What are the chemical and physical properties of 
asbestos? 

Asbestos, or amianth, is a fibrous silicate of c-alcium and 
magnesium, the length of the fibres being from less than one 
inch to five feet. A single fibre can be fused, but any 
considerable collection of fibres is practically infusible. It 
is a bad conductor of heat, it is unaffected by acids, may be 
woven into cloth. Is used as covering to prevent radiation, 
as from flues, and to prevent communication of heat to com- 
bustible substances, for filtering strongly acid liquids, etc. 

Mention two important ores of zinc, and describe the 
process by which the metal is obtained from one of the 
ores. 

Calamine or native carbonate, ZnCCv 

Zinc blende, ZnS. 

Calamine is first roasted in air. forming zinc oxide and CO, 



PHYSICS, CHEMISTRY AND METALLURGY. 331 

gas. The zinc oxide is then mixed with charcoal or coke, in 
earthenware retorts, and is subjected to downward distillation, 
when the vapor of the metal solidifies, yielding zinc. 

Write the equation showing the reaction of (a) hydro- 
chloric acid on zinc, (b) Sulphuric acid on zinc. 

(a) Zn 2 + 4HCl = 2ZnCL + 2H.,. 

(b) Zn 2 + 2H,S0 4 = 2Zn~S0 4 + 2H 2 . 

Give the properties of metallic zinc and state its uses in 
dentistry. 

It is a bluish- white metal, melts 779° F.. specific gravity 
6.9, is brittle and crystalline. When heated to 212° to 302° 
F. becomes ductile and malleable, retaining its malleability 
after cooling. When heated to 400° F., it again becomes 
brittle so that it can be powdered. It is volatile, and on 
heating, burns to form the oxide of zinc. It contracts mark- 
edly on cooling after heating, is harder than gold or silver, 
does not oxidize in air or moisture at ordinary temperatures. 

Used in dentistry for making dies for swaging metal plates, 
less often is used to make counter-dies. It is often a con- 
stituent of solders, and in the form of brass is frequently 
added to gold in making solder. Its oxide, chloride, and sul- 
phate enter into the composition of dental cements. Zinc 
chloride is used in dentistry as a disinfectant and obtunding 
agent. Its sulphate is astringent and emetic. Zinc is often 
added to alloy amalgams. 

Distinguish chemically between oxy=chloride of zinc 
and phosphate (oxy=phosphate of zinc). State the con= 
ditions indicating the use of each in dentistry. 

The liquid used in oxy-chloride of zinc cement is a solution 
of one oz. zinc chloride dissolved in 5 or 6 drams of water; 
the powder is calcined pure zinc oxide with a small amount 
of borax and silica added. 

The liquid used in oxy-phosphate of zinc cement is made by 
evaporating a solution of glacial phosphoric acid in water to 
a syrupy consistency ; the powder is pure calcined zinc oxide. 



332 PHYSICS, CHEMISTRY AND METALLURGY. 

Oxy-chloride of zinc cement is not permanent, sets slowly, 
shrinks markedly, is antiseptic, and is used for filling, lining, 
and restoring color to teeth. Oxy-phosphate of zinc cement 
is more permanent, lasting from two to seven years and is 
less irritating. 

Complete the following equations: 

BaO, + C0 2 + H 2 = 
PL + 3H 2 = 

Ba0 2 + C0 2 + H 2 = BaC0 3 + H„0 2 . 

PL, + 3H 2 = H 3 PO s + 3H1. 

Complete the following equations: 

As 2 ;) + 3H 2 S = 
H 2 ~S0 4 + NaN0 8 = 

As 2 3 + 3H 2 S = As 2 S :! + 3H 2 0. 

H,S0 4 + NaNo s = NaHS0 4 + HN0 3 . 

Form complete equations of the following: 

AgNO, + HC1 = 
PbCl 2 + H 2 S0 4 = 
CaO + H a O = 

AgNO :i + HC1 = AgCl + HN0 8 . 

PbCl 2 + II 2 S0 4 = PbS0 4 + 2HC1. 

CaO -f H 2 = Ca2HO. 

Complete the following equations: 
Mn0 2 + 4HCL = 
K,CO ;! + Ca(OH)2 = 

Mn0 2 + 4IIC1 = MnCl 2 + 2H 2 + Cl 2 . 

K 2 C0 3 + Ca(OH) 2 = CaCO a + 2KOH. 

State the chemical names of the following compounds: 

Kl, CaS0 4 , IIgCl 2 , FeO, NH 4 OH. 

Kl, potassic iodide; CaS0 4 , calcic sulphate; HgCL, mer- 
curic bichloride; FeO, ferrous oxide; NH 4 OH, amnionic 
hydroxide. 



PHYSICS, CHEMISTRY AND METALLURGY. 333 

Write the chemical name of each of the following: 
White lead, gypsum, calomel, copperas, blue vitriol. 

White lead is basic plumbic carbonate. 
Gypsum is natural calcic sulphate. 
Calomel is mercurous proto chloride. 
Copperas is ferrous sulphate. 
Blue vitriol is cupric sulphate. 

Write the chemical name of each of the following: 
Muriatic acid, quick=lime, salt, cinnabar, Epsom salts. 

Muriatic acid is hydrogen chloride or hydrochloric acid. 
Quicklime is calcium oxide. 
Salt is sodium chloride. 
Cinnabar is mercuric sulphide. 
Epsom salts is magnesic sulphate. 

State approximately the number of (a) inches in one 
meter, (b) grains in one gram. 

(a) 39.34 inches, (b) 15.432 grains. 

What is a liter? What fraction of a meter is a milIU 
meter? 

A liter is equivalent in measure to 33.81 English fluid- 
ounces, is the unit in the metric system for measuring capa- 
cities, will contain 1000 cubic centimeters, and, if of cubical 
form, would measure on each side one decimeter or 3.937 
inches in length. 

A millimeter is the one thousandth part of a meter. 

Convert 36 C into the corresponding reading F. 

36°C X I = 64f + 32 = 96±°F, Ans. 

Mention the standard of measure in the Metric System 
and state how this standard was determined. 

The meter, selected because it represents the one ten-mil- 
lionth of the distance from the earth's equator to either north 
or south pole. 






334 PHYSICS, CHEMISTRY AND METALLURGY. 

Define ohm, ampere, volt. 

The ohm is the unit of electric resistance, and is equal to 
the resistance to the electric current offered by 250 feet of 
pure copper wire of ^ inch diameter. 

The ampere is the unit of current strength (electric), and 
electric energy having an electro-motive force of one volt en- 
countering a resistance of one ohm will then exhibit a cur- 
rent strength of this unit one ampere. 

A volt is the unit of electro motive force, -and represents 
a tension or pressure required to maintain a current of one 
ampere through a resistance of one ohm. 

Define acid, base, salt, neutral salt. 

An acid is a sour substance, always containing hydrogen, 
capable of uniting with and neutralizing a base to form a salt 
and water, often having a corrosive action upon the tissues, 
and turning litmus to a red color, and bleaching organic 
substances. 

A base is the oxid or hydrate of a metal (or electro positive 
radical) which combines with and neutralizes acids to form 
salts and water, emulsifies fats forming soaps, has a harsh 
acrid taste ; if soluble, its solution gives blue color to litmus. 

A salt is a substance formed by replacing all or part of the 
hydrogen of an acid with metal atoms (or electro positive 
radicals). 

A neutral salt is one which when in solution would fail 
to change litmus in color. 

Define allotropism, nascent state, crystalline, structure, 
amorphism. 

Allotropism refers to the condition in which substances 
alike in chemical composition may exhibit different proper- 
ties; as we find in red and in yellow phosphorus. 

The nascent state refers to a freshly produced condition 
of an element in which it has been supposed that the com- 
ponent atoms have not as yet united to form molecules. 

By crystalline structure we mean that the molecules or par- 



PHYSICS, CHEMISTRY AND METALLURGY. 335 

tides of a substance are arranged in definite geometrical 
forms. 

Amorphism indicates lack of crystalline stnicture. 

Define lixiviation. 

Lixiviation consists in washing wood ashes and other por- 
ous substances with water so as to dissolve out certain salts 
(like potassium carbonate) from the porous material. 

Define radical. 

A radical is an atom nncombined ; a compound radical is 
a group of atoms with their respective valencies unsatisfied, 
and it enters into chemical changes like an elementary atom. 

Describe the effect produced by increasing the vibration 
of the molecules of a mass. 

1. Rise of temperature. 

„ , . . , f Increase in volume. 

2. Internal work < ~. „ 

| Change of state. 

3. External work 1 Overcoming pressure. 

Explain each of the following: Reflection of light, re- 
fraction of light, dispersion of light. 

Reflection of light is the rebounding of light from a pol- 
ished surface. 

Refraction of light is the bending or change of direction 
of light rays on passing from a medium of one density into a 
medium of different density. 

Dispersion of light is the splitting of white light into the 
colors of the spectrum. 

Define five of the following: Alloy, precipitate, amal = 
gam, allotropism, reagent, isomerism, chemism. 

An alloy is the union of two or more metals usually effected 
by fusion. 

A precipitate is a new insoluble substance formed, through 
chemical action, on bringing in contact solutions of appro- 
priate substances. 



336 PHYSICS, CHEMISTRY AND METALLURGY. 

An amalgam is an alloy in which one of the component 
metals is mercury. 

A reagent is an active chemical substance, usually in solu- 
tion, which exerts chemical action upon substances to which 
it is added. 

Isomerism refers to that condition in which two or more 
substances, composed of the same elements, in the same per- 
centage composition, may be distinctly different substances 
exhibiting different properties. 

Mention the chief substances that serve as plant food. 

Water, C0 2 , ammonia, potassium and sodium salts, phos- 
phates of calcium and magnesium, silicates of potassium and 
sodium. 

Describe the formation of organic substances in the 
plant. 

The plant extracts from the soil mineral salts in solution 
and from the air CO.,, and separating and giving off the 
oxygen from the latter, bring the carbon in chemical contact 
with the element present in mineral salts, and through the 
presence of moisture favoring union complex molecules con- 
taining carbon, are constructed by a process of synthesis giv- 
ing rise to the tartrates, citrates, malates, etc., of different 
metals (usually potassium, sodium or calcium). 

What elements enter into the animal system as neces- 
sary constituents? 

Potassium, sodium, calcium, magnesium, iron, oxygen, 
hydrogen, nitrogen, sulphur, phosphorus, chlorine, fluorin, 
carbon. 

Mention three groups of organic substances chiefly used 
as a food by animals. 

Proteids, fats and starches, and sugars (carbo-hydrates). 

State the most important substances found in coal tar. 

Benzine, toluene, naphthalene, anthracene, ammonia, ani- 
line, pyridine, carbolic acid, acetic acid, etc. 



PHYSICS, CHEMISTRY AND METALLURGY. 337 

Describe the action of chlorine on alcohol. 

Chlorine may remove hydrogen from alcohol, or chlorine 
may replace hydrogen in the alcohol molecule. 

Describe the preparation and mention the properties of 
iodoform. Write the formula and state the chief uses of 
iodoform. 

Iodoform separates in crystals on cooling a hot solution of 
iodine, alcohol and potassium hydrate. Iodoform occurs in 
yellow hexagonal plates, smells of saffron, melts at 120° C, sub- 
limes with but slight change, is insoluble in water, but dis- 
solves in alcohol and ether. The formula of iodoform is 
CHI 3 , and it is used as a local anesthetic, slight stimulant to 
granulating or ulcerous surfaces, absorbent of discharges, 
etc. ; its solution in ether is less disagreeable in odor. 

Describe a method of preparing sulphuric ether. Men= 
tion the properties of sulphuric ether. 

A mixture of ethyl alcohol and sulphuric acid is heated 
at 140 °C in a retort, the arising vapor of ether is received in 
a condenser, and alcohol in small quantity is allowed to con- 
tinuously enter the retort. 

Ether is a colorless, limpid, mobile liquid, of sharp burn- 
ing taste, a characteristic odor, specific gravity of .723, boils 
at 34.5°C, slightly soluble in water, highly inflammable, and 
its vapor mixed with air is explosive. 

What is a graphic formula? Give an example. 

A graphic formula is a diagramatic representation of the 
manner in which atoms or radicals unite to form molecules. 
Graphic formula of ethyl alcohol is 

H 

I 
H— C— OH 

I 
H— C— H 

I 
H 

22 



338 PHYSICS, CHEMISTRY AND METALLURGY. 

State the source of each of the following acids: Citric, 
acetic, salicylic, oxalic. 

Citric acid is obtained from lemons. 

Acetic acid from oxidation of alcohol. 

Salicylic acid from wintergreen berries or coal tar. 

Oxalic acid is obtained by heating sawdust and caustic 
potash, and treating the result successively with water, cal- 
cium hydrate and sulphuric acid. 

From what is cocaine derived? Mention the salt of 
cocaine that is chiefly used in surgery. 

From the leaves of the erythroxylon coca. The muriate 
or hydrochlorate of cocaine is used in surgery. 

Mention three chemical varieties of sugar and give their 
sources. 

Cane sugar (saecharum) from the sugar cane. 
Milk sugar (lactose) from milk. 
Clucose from fruit juices. 

Describe the dry process of refining gold. 

Remove iron of steel with a magnet. Place the impure 
gold in a boraxed crucible and melt under flux of potassic 
carbonate; add from time to time a mixture of potassic ni- 
trate and anhydrous borax, stirring constantly, and when a 
sample, withdrawn from crucible and cooled, becomes freely 
malleable, pour the metallic contents of crucible into the in- 
got mould. 

State the effect of tin on an alloy of gold. 

A less proportion than 10% of tin in a gold alloy does not 
greatly impair the malleability of gold. It greatly lowers 
fusing point of gold. It overcomes tendency to expand when 
a gold alloy is used as filling. It diminishes conductivity. 

Write the formula of a standard three-metal alloy for 
amalgam fillings. 

Flagg's submarine dental amalgam alloy contains 35 parts 
tin, 60 parts silver, 5 parts copper. 



PHYSICS, CHEMISTRY AND METALLURGY. 339 

Write the formula of starch and mention the class of 
chemical compounds to which it belongs. State the re= 
action of the starch. 

Starch C e H 10 5 belongs to that subdivision of the carbo- 
hydrate group known as the polysaccharids. Starch is neu- 
tral in reaction. 

State the forms in which arsenic occurs in nature. De- 
scribe a method of preparing As.,0... 

Arsenicum occurs in nature combined with sulphur as 
As 2 S 3 called orpiment, and As 2 S 2 called realgar; also exists 
in combination with nickel and iron, with cobalt and with a 
few other metals existing as arsenides. 

As 2 3 may be prepared by roasting any arsenical coin- 
pound in air and condensing by cooling the resulting vapor 
of As 2 3 . 

Describe a test for C0 2 . 

Pass the suspected gas into lime water, when, should it be 
C0 2 , a deposit of calcium carbonate forms. 

Describe a method of precipitating platinum for its 
solution. State the color of the physical condition of the 
precipitate. 

Dissolve platinic dioxid Pt0 2 in dilute sulphuric acid; 
to this solution of platinum add an excess of ammonia, when 
a black precipitate of powdery black metallic platinum, known 
as fulminating platinum, is produced which detonates vio- 
lently if heated to 400° F. 

State the source of bromine and the group of elements 
to which it belongs. Describe a method of preparing 
bromine. 

Mineral spring waters containing magnesic bromide, or sea 
water. Bromine is a member of the halogen group. It may 
be prepared by passing chlorine through a strong watery 
solution of a bromide and condensing the resulting vapor of 
bromine. 



340 PHYSICS, CHEMISTRY AND METALLURGY. 

Mention the principal ore of tin and describe the process 
of extracting metallic tin from the ore mentioned. 

Tin, stone or cassiterite, SnO,, is the ore yielding tin. Tin 
is extracted from tin stone 'by washing latter till free from 
earthly impurities, then crushing, then washed to remove the 
light gangue, then roasted at low temperature driving off 
sulphur and arsenic, then exposed to air and moisture caus- 
ing copper present to form copper sulphate, then washed with 
water to dissolve and remove the copper sulphate and all 
lighter oxids. This result known as black tin is then mixed 
with about 15% of fine anthracite coal and fused for several 
hours in a reveiberatory furnace, when the metal separates, 
and is ladeled into moulds. 

Define molecular weight. Give the molecular weight of 
each of the following: Ag No : „ H.SO.,, Na Ci. 

The molecular weight of a compound is the sum of the 
atomic weights (or multiples of the atomic weights) of its 
constituents. The molecular weight of a gas is twice its 
density comparable with hydrogen. 

Molecular weight of AgN0 3 is 170. 

Molecular weight of H 2 S0 4 is 98. 

Molecular weight of NaCl is 58.5. 

Give the atomic weight and fusing point of argentuiru 

Atomic weight of silver is 108; it fuses at 1832° P. 



HISTOLOGY. 



By what tissues are nerve fibers held together? 

In the central nervous system, nerve fibers are held to- 
gether by neuroglia. This consists of branched cells, con- 
nective tissue in function, though epiblastic in origin. 

In peripheral nerves, the fibers and bundles of fibers are 
bound together by true connective tissue sheaths. That 
covering the nerve is called the epineurium ; that surrounding 
the bundles of nerve fibers is the perineurium ; uniting the 
fibers in the bundle are extensions from the perineurium, the 
endoneurium. These consist of bundles of ordinary connec- 
tive tissue fiber's. 

What tissues are derived from the parablast? 

The parablastic tissues include those usually spoken of as 
mesodermic. except the endothelial cells and the smooth 
muscle fibers (see page 352, Q. " What tissues are derived 
from the mesoblast?") . 

Mention the nourishing fluids of the body. 

The blood and the lymph. 

Describe the blood platelets. 

These elements are very unstable when blood has been 
drawn, and therefore not easily demonstrated in the ordinary 
preparation. They occur, nevertheless, as round, flattened 
bodies. They are colorless and have an average diameter 
of one-third that of a red blood corpuscle. Their function 
though not definitely understood seems to be in relation with 
the phenomenon of coagulation of the blood. 

(341) 



342 HISTOLOGY. 

Describe a method of hardening tissues for microscopic 
sections. 

The tissues to be examined should be removed as freshly as 
possible from a recently killed animal and cut into pieces not 
more than two cm. in thickness. They should then be placed 
in a "fixative." such as absolute alcohol or Midler's fluid; the 
latter should be changed as soon as it becomes cloudy. Alco- 
hol is more rapid in its action ; small pieces can be fixed in a 
few hours, while Midler's fluid requires at least two weeks. 

After fixation the tissues are hardened in increasing 
strengths of alcohol, beginning at eighty per cent, then ninety- 
five, and finally absolute alcohol. The tissue is now ready 
for infiltration with a suitable material which will give dens- 
ity, thus aiding in the cutting. Either paraffin or celloidin 
may be used. 

The tissue must now be placed in a solvent of the substance 
used for infiltration. If celloidin be used, the solvent 
is equal parts of alcohol and ether. In this (A & E) 
the tissue should remain several hours (12-24), then in a solu- 
tion of thin celloidin for an equal length of time. Following 
this the tissue is placed in thick celloidin, allowing it to re- 
main for a sufficient length of time to permit an infiltration 
of the tissue with celloidin. It is finally mounted on a block, 
surrounding the tissue with a layer of thick celloidin which 
hardens when exposed to the air. The block and tissue should 
then be kept in eighty per cent, alcohol until ready for cutting. 

What is fibrin? 

As the name implies, it is a substance, fibrous in nature, 
which is formed during the process of coagulation of the 
blood. It is produced by the fibrin-forming principles, fi- 
brinogen and fibrin ferment. Fibrin appears in the form of 
very delicate, interlacing, straight threads. These occupy a 
position between the blood corpuscles; sometimes they seem 
to radiate from a common center. 



HISTOLOGY. 343 

State the function of cilia. 

Cilia occur upon surfaces in localities in which fluids are 
to be propelled or foreign bodies removed, e. g. raucous mem- 
brane of the respiratory tract. 

Describe the intercellular constituents of connective 
tissue. Describe one variety. 

These may be said to consist of two elements, fibers and the 
matrix. The fibers may be in the form of delicate, white 
connective tissue threads, formed probably at the expense of 
the cellular elements, placed parallel without anastomosis; or, 
the fibers may be yellow, highly refractile, anastomosing 
threads. The matrix of connective tissue gives to it its char- 
acter, varying in density in the several tissues. In mucous 
or embryonic tissue it is colorless, transparent, gelatinous. 

Describe the microscopic appearance of pavement epi- 
thelium. 

This variety consists of a single layer of cells held together 
by a small amount of intercellular cement substance. When 
viewed from the surface it presents the appearance of a 
mosaic. The cells are usually squamous in shape. 

Define marginal zone. 

This term is applied to the striated border seen at the 
free margin of some cells, notably the epithelium in the 
small intestine. 

Describe the development of elastic fibrous tissue. 

In the elastic connective tissue the fibers are formed in 
the matrix, probably at the expense of the connective tissue 
cells. In the beginning, rows of chain-like arrangements of 
granules are seen. Subsequently, these granules become 
fused, forming branched elastic fibers. 

Describe Peyer's Patches. 

These are masses of small round cells (lymphoid) in a 
connective tissue reticulum, situated in the sub-mucous and 



344 HISTOLOGY. 

mucous coats of the lower part (ileum) of the small intestine. 
They are also known as agminate glands. 

Describe the process by which osteoblasts are converted 
into bone cells. 

Osteoblasts are the cells active in the production of osseous 
tissue. During the process the osteoblasts soon become en- 
veloped in the bone matrix, occupying minute spaces — the 
lacunae. The cells, having ceased their action in the pro- 
duction of bone, become bone cells. 

Describe the structure of the mucous membrane lining 
the oral cavity. 

An epithelial covering, of the stratified squamous variety, 
and a connective tissue base form the essential structural ele- 
ments. The outer layer of cells is flattened and scale-like ; 
the deepest layer is of columnar cells, sometimes named the 
Malpighian layer; the intervening layers are of polyhedral 
cells. The connective tissue portion is the tunica propria, 
upon which rests the epithelium. It consists of somewhat 
densely arranged, while fibrous connective tissue in which 
are carried blood vessels, nerves and lymphatics. Projections 
of the tunica propria upward into the epithelium carry the 
terminal vessels and nerves. These projections are termed 
papillae and are best developed on the tongue and gums. 
Down-growths of the epithelium into the connective tissue 
are arranged in the form of sacs, clusters of which unite 
with a common duct. These are mucous glands, the ducts 
of which open on the surface of the mucous membrane. On 
the gums the epithelial layer of the mucous membrane is 
very thin. This accounts for the readiness with which the 
gums bleed. On the hard palate, the mucous membrane is 
thin and tightly adherent to the periosteum. 

State where marrow is found. Describe the varieties 
of marrow. 

Marrow is found in the interior of bone ; in the medullary 



HISTOLOGY. 345 

canal in the shafts, and at the extremities of long bones ; 
also in the interior of the flat and irregular bones. Varia- 
tions in marrow are noticed in bones at different ages and 
also in different anatomical locations. In the cavities of long 
bones, in adult animals, the marrow is yellow, due to the ac- 
cumulation of fat within it. The marrow of all bones in 
young animals is red, because of the great number of red 
blood corpuscles. The extremities of long bones (adult) also 
contain red marrow. 

Red marrow consists of (a) marrow cells, or myelocytes, 
which resemble leucocytes, though larger, containing rather 
large nuclei. In the protoplasm of the cells are formed 
granules which stain with neutral stain, thus distinguishing 
them from mono-nuclear leucocytes. (b) Nucleated red 
blood corpuscles are formed in the marrow. They later 
loose their nuclei before entering into the circulation, (c) 
Cells, the protoplasm of which stains deeply with eosin ; some 
of these cells are mono-nuclear, others are polymorpho- 
nuclear, (d) Leucocytes and lymphocytes, (e) Giant cells 
(myeloplaxes) which are large cells, polynuclear as a rule, 
and are the osteoclasts of bone development. 

Yellow marrow contains few cells, an appreciable amount 
of areolar tissue containing fat. 

Describe the method of cutting tissues for microsc-opic 
section. 

Good sections may be cut by hand with a razor ground flat 
on one side, but the best result may be had by use of the 
microtome. For celloidin sections, the razor is arranged ob- 
liquely so that a long stroke may be made, using as much of 
the edge of the knife as is possible in cutting each section. 
The tissue block, held in a suitable clamp, is kept wet with 
eighty per cent, alcohol ; the knife should also be kept flooded 
with alcohol, so that the sections can easily be straightened 
without tearing them. 

For paraffine-embedded tissue, the sections are cut dry, and 
removed from the knife with a camel 's-hair brush. 



346 HISTOLOGY. 

Describe the cellular elements of connective tissue. 

The cells of connective tissue vary in shape with the variety 
and age of the tissue. The youngest cells occur in greatest 
number and more closely arranged than the older cells in the 
intercellular substance. Connective tissue cells may be round, 
oval, spindle-shaped, stellate; in the last instance they bear 
delicate protoplasmic prolongations, which interlace. In 
areolar tissue are found round and oval cells, fixed cells; 
wandering cells resembling leucocytes. Tendons contain flat 
cells arranged in lamellae between the bundles of fibers. 
Cartilage contains spindle and angulated cells, the latter be- 
ing the older. Bone cells are irregular in shape. They 
have delicate processes which lie in canaliculi. 

Describe the microscopic appearance of columnar epi- 
thelium. 

Columnar epithelium may be simple or stratified. The cells 
are cylindrical in shape; the nucleus, usually oval, is situated 
at the base of the cell which rests on end upon the supporting 
membrane. When several layers of cells exist, it is only the 
superficial layer which has its cells distinctly columnar. The 
deeper cells are irregularly columnar or polyhedral. Colum- 
nar epithelium may or may not be ciliated. 

State how spongy bone is converted into compact bone. 

This is accomplished by the absorption of spongy bone, 
which thereby forms in it large oval spaces, the Haversian 
spaces, within which new formation of bone takes place. The 
bone cells deposit, layer by layer, new bone, until a narrow 
canal, the Haversian canal, remains instead of the former 
space. 

Describe fibro=cartilage. 

This variety consists of a hyaline matrix in which are em- 
bedded cartilage cells and fibers. The cells usually occur in 
groups of two oi - three in a lacuna, surrounded by a zone of 
clear matrix. Throughout the remainder of the matrix are 



l S J 



HISTOLOGY. 347 

arranged delicate fibrils of white fibrous tissue. The trans- 
formation of hyaline cartilage into fibro-cartilage is well de- 
monstrated at the attachment of the ligamentum teres to the 
head of the femur. Here the fibers of the ligament extend 
into the hyaline matrix of the articular cartilage. Fibro- 
cartilage is without a distinct perichondrium. 

Describe the development of cartilage. 

Cartilage grows from the inner or chondrogeuic layer of 
the perichondrium which consists of spindle-shaped connec- 
tive tissue cells. The cells produce the matrix, depositing it 
in layers beneath this membrane. As the cartilage grows, 
the ceils remain in small spaces, lacunae, within the matrix, 
becoming larger and rounded as the age of the tissue ad- 
vances. The youngest cartilage cells are spindle-shaped, ar- 
ranged in rows immediately beneath the perichondrium. 

Describe the reticulum of lymphoid tissue. 

The reticulum of lymphoid tissue consists of an interlace- 
ment of bundles of white fibrous connective tissue, loosely 
arranged. Upon the bundles, particularly at their junctions, 
occur flattened or stellate connective-tissue cells. It is in 
this reticulum that the cells of the lymphoid tissue occur. 

Describe myxomatous tissue. 

This tissue is the youngest form of connective tissue. It 
consists of a jelly-like, transparent, homogeneous matrix in 
which are arranged stellate connective tissue cells, which have 
delicate protoplasmic prolongations. The branches frequently 
anastomose, forming a delicate reticulum. 

Describe Nasmyth's membrane. 

This structure is the remains of the enamel organ. As the 
tooth becomes larger the deepest layer of cells is forced toward 
the superficial layer. The intervening layers atrophy, and 
thus the enamel organ becomes reduced to a thin membrane 
which invests the crown of the tooth. This membrane per- 



348 HISTOLOGY. 

sists for a short time only after the tooth has been erupted, 
soon wearing away as the result of friction. 

Describe the microscopical appearance of adipose tissue. 

This tissue consists of a delicate reticulum of white fibrous 
connective tissue, containing comparatively large interstices 
in it. In the spaces are to be -een cells, the protoplasm of 
which has been displaced, the cell-wall distended and occu- 
pied by fat. The nucleus of the cell is pushed to one side, 
being displaced by the globule of fat. The fat cells are usu- 
ally in groups surrounded by areolar tissue; a rich blood 
supply is found in this tissue. 

Give the microscopic appearance of non=medullated 
nerve fiber. 

Such a nerve fiber is distinguished from the medullated 
nerve fiber by the absence of the medullary sheath. It consists 
of an axis cylinder and a neurilemma; the fibers branch freely 
previous to their termination, which is not true of medul- 
lated nerve fibers. The axis-cylinder is distinctly fibril] ated. 
Nuclei are numerous, being irregularly placed along the 
course of the fiber, lying beneath the neurilemma. 

What are lacunae? 

Lacunae are spaces found in compact connective tissue, such 
as cartilage and bone (cementum). They contain the cells of 
the particular tissue and also lymph. In bone they commu- 
nicate with one another by means of minute capillary-like 
channels, called canaliculi. 

Describe the structures composing the heart. 

Pericardium, which covers the heart and forms a closed sac 
is a serous membrane, consisting of a single layer of endothe- 
lial cells, resting upon a basement membrane of fibro-elastie 
connective tissue. 

The myocardium, or the muscular tissue of the heart, 
forms the bulk of the organ. It consists of a dense network 
of branching muscle fibers nucleated and without a sarco- 



HISTOLOGY. 349 

lemma. The fibers are short, cylindrical in shape, grouped 
together in bundles, united by connective tissue. On the sur- 
face of the muscle the connective tissue blends with that of 
the pericardium. 

The endocardium, the lining of the heart cavities, is a 
serous membrane, with a single layer of endothelial cells rest- 
ing on a connective tissue base. It is continuous with the 
intima of the blood-vessels. At the orifices of the heart 
chambers the endocardium presents reduplications, to form 
the heart valves, which are reenforced with bands of fibrous 
connective tissue. 

Mention the tissues derived from the hypoblast. 

The epithelium of the digestive tract and the associated 
glands, except the oral cavity and its glands; the epithelium 
of the respiratory tract; urinary bladder and the urethra; 
ureters; epithelium of the thyroid body and thymus (Hassal's 
corpuscles) ; Eustachian tube and middle ear. 

Give the location of stratified epithelium. 

Squamous : 

Oral cavity — pharynx, esophagus, epiglottis — true and false 
vocal cords, epidermis, cornea, external auditory canal, vagina, 
female urethra, beginning and end of male urethra, urinary 
bladder, ureters, pelves of the kidneys (transitional epithe- 
lium) . 

Columnar (non-ciliated). 

Olfactory, part of the nasal fossae, part of vas-deferens. 

Columnar (ciliated) : 

Eustachian tube, part of tympanic cavity, lachrymal pas- 
sage, respiratory part of nasal fossae, ventricle of larynx, 
trachea and bronchi, epididymis and the first part of the 
vas-deferens. 

How do nerve fibers terminate? 

Before reaching its termination a nerve fiber loses its 
myelin sheath ; next, its neurilemma, and continues for a 



350 HISTOLOGY. 

short distance as a naked axis-cylinder; these break up into 
fibrilla? and terminate as general free endings. 

Nerves may also end in special nerve-endings, as in tactile 
cells or tactile corpuscles or end bulbs. 

.Motor endings in muscle are in the form of inter-muscular 
plexuses, which ultimately become naked axis-cylinders, and 
these in turn break up into fibrilla? and terminate in motor 
end plates. 

Describe the perforating fibers of Sharpey. 

These are transversely placed fibers occurring in the super- 
ficial lamellae of bone and represent extensions of periosteum 
which have not undergone calcification. 

They are found most numerous in spongy bone and in the 
interstitial lamellae of compact bone. 

Describe the centers of ossification. 

In the development of bone, particularly enchondronal 
bone, are found areas in which the first changes in the bone- 
forming process take place. These areas are the so-called 
centers of ossification. 

The cartilage cells multiply and increase in size, becoming 
separated from one another by an increase in the intercel- 
lular substance and finally are arranged in vertical rows. It 
is here that the first deposition of calcareous substance takes 
place, and is known as the "primary areola of Sharpey." 

(a) What are giant cells? (b) Give their function. 
(c) What will cause their action to cease? 

(a) <iiant cells are large, multi-nuclear cells found in bone 
marrow. (See answer to question, "Describe varieties of 
marrow. " page 844). 

(b) Their function is that of bone resorption. 

(c) Isolation by osseous tissue will cause their action to 
cease. 

Describe the ossification of the alveolar process. 
Before birth, the alveolar process presents on its superior 



HISTOLOGY. 351 

margin a deep longitudinal furrow which corresponds to the 
future tooth-sockets, and in which are contained the devel- 
oping temporary teeth. Later, the walls of the process are 
built up, so as to surround the root of each tooth with a bony 
wall. This same wall is resorbed with the roots of the tem- 
porary teeth when they are shed. For the permanent teeth 
the process is rebuilt as before. 

What tissues of the teeth are developed from the con- 
nective tissue group? 

Dentine, eementum, pulp and its vessels. 

What are the Striae of Retzius? 

The stripes of Retzius are dark lines in the enamel passing 
in a direction generally parallel to the surface of the enamel. 
These are due, no doubt, to inequalities in development, and 
also in density of its substances. 

Describe the Stratum Malpighii. 

This is the deepest layer of cells of the oral epithelium, 
which comprises the active portion of the enamel organ. It 
consists of columnar- and polyhedral-shaped cells. 

Describe the blood supply to the tooth pulp and peri= 
eementum. 

The arterial twigs enter the pulp-canal by the apical fora- 
men and break up into a plexus of capillaries arranged 
densely, at the periphery beneath the layer of odontoblasts. 
From the same artery branches extend upwards into the peri- 
cementum; branches are again distributed laterally in the 
pericementum, some of which pass for a short distance into 
the eementum and the adjacent alveolar wall. 

What is cartilage? 

Cartilage is a dense variety of connective tissue. It is 
more or less translucent, containing in the matrix a principle 
known as chondrin, which gives density, and to a degree 
elasticity, to the cartilage. Cartilage occurs at the articular 



352 HISTOLOGY. 

surfaces of all long bones; between the articulations of some 
bones; the costal cartilage; external ear; and in the embryo 
— the entire skeleton, except the bones of the face and cra- 
nium, and part of the inferior maxilla. 

Name the three organs which effect the calcification of 
the tooth. 

The ameloblasts of the enamel organ, the odontoblasts of 
the dentinal papilla, and the cementoblasts of the alveolar 
periosteum. 

Describe a transverse section of the root of a tooth, as 
seen under the microscope. 

In the interior of the root will be seen an opening; this 
corresponds to the lumen of the pulp-canal. Whether or not 
the pulp will be seen will depend upon the method of prep- 
aration of the specimen. Dried specimens are best for ex- 
amining the structure of the bulk of a tooth, in which 
preparation the pulp will not be demonstrable. On the 
periphery will be seen a zone of osseous tissue, the cemen- 
tum ; the exterior of this may or may not show the remains 
of the peridental membrane. Internal to the cementum lies 
the dentine, the tubules of which arranged radially extend 
from the pulp-canal as a center. 

With what do the dentinal tubules connect at their 
inner extremities? 

The pulp-chamber. 

What tissues of the oral cavity are formed from the 
epiblastic layer? From the mesoblastic layer? 

From the epiblast are developed the epithelium of the 
mouth, including its glands, the enamel organ, and nerves. 

Prom the mesoblast are developed the tunica propria of the 
rnucous membrane, its blood-vessels and lymphatics, muscle 
fibers, dental papillae and their products. 



HISTOLOGY. 353 

Where are the lines of Schreger found? (b) Salter? 

(a) Schreger 's lines occur throughout the dentine. 

(b) Salter's incremental lines are found in the outer layer 
of dentine. 

Name the different kinds of cells found in the alveolo- 
dental membrane. 

This membrane contains, as does other connective tissue, 
spindle-shaped connective tissue cells. In addition, it con- 
tains special cells. The cementoblasts for the production of 
cementum ; the cementoclasts, for resorption. 

With what do the dentinal fibrils connect? 

The odontoblasts. 

What is the purpose of secondary dentine? How does 
it differ from true dentine? 

Secondary dentine, when formed in carious teeth, serves 
to supply the loss sustained by the weakening of the wall. 
Secondary dentine is frequently found in the teeth of old 
persons without caries. This is due to stimulation of the 
odontoblasts by some irritant. 

Secondary dentine differs from true dentine in the fact 
that it is usually irregularly and imperfectly calcified. It is 
also known as osteo-dentine. 

What form of epithelium lines the oral cavity? From 
what elementary tissue is it developed? 

Stratified squamous ; developed from the epiblast. 

State the various cell layers of the completed enamel 
organ. Give their relative position. 

The layer of ameloblasts which forms the deepest layer lies 
adjacent to the dental papilla ; the stellate reticulum, or layer 
of polyhedral cells, which occupy the interior of the enamel 
organ ; the superfiial epithelial layer, which is a direct con- 
tinuation of the oral epithelium ; between the superficial stra- 
23 



354 HISTOLOGY. 

turn and the stellate reticulum lies the "stratum interme- 
dium." 

Where does calcification first appear in a developing 
tooth, and what size and shape is the dentinal germ? 

"Calcification of dentin begins on the coronal extremities 
of the crowns. The dentinal germ is the same size and shape 
as the crown of the future tooth." 

Describe the different tissues of the teeth and give their 
location? 

Enamel, dentine, cementum and pulp. The enamel covers 
the crown of the tooth, dentine forms the body of the tooth 
and is intermediate in position between the enamel and pulp; 
the pulp occupies the central chamber of the tooth and the 
cementum covers the roots of the teeth. 

How do the arterial vessels in the pulp differ from those 
just outside of the apical foramen? 

The arterial vessels in the pulp are found as a capillary 
network, composed of a layer of endothelial cells, while those 
outside of the foramen are much larger, consisting of two 
coats. 

With what is the surface of the gum covered? 

Mucous membrane. 

What is the function of the peridental membrane and 
how does it receive its blood supply? 

The function of the peridental membrane is to hold the 
tooth in its socket, give sense of touch to the tooth, act as a 
cushion to receive shock due to mastication, to nourish the 
tooth when the pulp is devitalized and to nourish the cemen- 
tum of the tooth. It receives its blood supply from the same 
arterial branch as the tooth, this branch giving off several 
twigs before entering the apical foramen. 



HISTOLOGY. 355 

What is the structural difference between an artery 
and a vein? 

Veins have, on the whole, much thinner walls than arteries 
in proportion to the calibre of the vessels. The endothelial 
cells of veins are broader and shorter than in arteries. Veins 
contain less muscle but more connective tissue than arteries. 

Describe fully the white corpuscles of the blood and 
give their origin. 

The white corpuscles at rest are globular nucleated masses 
of protoplasm about -^rmf of an inch in diameter. There are 
a number of varieties. The small mononuclear or lymphocyte, 
the large mononuclear or transitional, the polymorphonuclear, 
which is the most abundant, and the eosinophile containing 
coarse granules readily stained with eosin. 

The leucocytes have the power to throw out pseudopodia, 
or, as it is called, amoeboid movement. They originate in the 
lymphatic tissue and in the marrow of bones. 

How is secondary dentine formed? 

By the odontoblasts being stimulated into activity by irri- 
tation of the pulp. It is most frequently caused by the ad- 
vance of the caries. 

How is cellular activity stimulated in the resorption of 
the roots of deciduous teeth? 

By the vascular papilla and probably by the pressure 
caused by the advance of the permanent teeth. 

How and from what source does a tooth receive its 
blood supply? 

By means of the pulp and pericemental membrane ; from 
the inferior dental to the inferior teeth, and from the alveo- 
lar and infra-orbital to the upper teeth. 

Describe the natural means by which the deciduous 
teeth are shed. 

The resorption begins at the apical extremities of the root 



356 HISTOLOGY. 

and gradually progresses towards the crown. It is brought, 
about by the agency of the osteoclasts; resorption taking place 
in the order of eruption contained in vascular papillae. 

Describe the dental tubuli. 

The dental tubuli are small wave-like canals which run 
from the periphery of the pulp in a perpendicular direction 
to the surface. They vary in size from 1.1 to 2.3 microns. 
They anastomose freely. 

Describe an odontoblast. 

They are large, elongated, multipolar, nucleated cells. Be- 
fore dentinification they are spheroid. During this process 
their extremities become somewhat flattened and square. 

What tissue is developed from the outer layer of cells, 
and what of the inner layer of the follicular sac? 

From the outer, the peridental membrane is developed and 
from the inner layer the cementum is developed. 

From what sources do the different structures of a 
tooth receive their nourishment? 

The enamel, from the dentine ; dentine, through the pulp ; 
pulp, from its vascular supply ; cementum, from the peri- 
dental membrane. 

What is spongioplasm? 

Spongioplasm is a part of the protoplasm of a cell. It is 
a very delicate network which supports the fluid portion of 
the protoplasm. 

What is the nucleus of a cell? 

The nucleus is usually a round or oval body situated in 
the interior of the cell body. It consists, like the protoplasm, 
of two parts: (1) The chromatin, having, as the name im- 
plies, a great affinity for stains; it is arranged in the form 
of a delicate reticulum. (2) The achromatin, a clear semi- 
fluid substance, staining feebly, if at all, and occupying the 
meshes of the chromatin. Within the nucleus may be seen 



HISTOLOGY. 357 

one or more smaller rounded bodies — the nucleoli. The nu- 
cleus is in many instances limited by a distinct nuclear 
membrane. 

What is the nuclear matrix? 

The nuclear matrix is the inter-fibrillar substance of the 
nucleus. A clear semi-fluid, homogeneous substance. 

Is dentine developed inwardly or outwardly? 

Dentine develops from without toward the papilla. 

In what manner does dentine increase? 

By a gradual deposit by the odontoblasts, of layers of a 
substance which later becomes calcified. 

What would be the result of exposing dentine to the 
action of a strong acid for several days? 

The earthy substance would be removed and a substance 
yielding gelatin would remain. 

What is the structure of human enamel? 

Enamel is an exceedingly hard substance. It is composed 
of elements prismatic in shape, usually six-sided, placed verti- 
cally to the dentine, are united by a cement substance. It 
exhibits parallel stripes representing strata of lime salts de- 
posited, called the stripes of Retzius. 

Give the varieties of connective tissue. 

White fibrous. Yellow elastic. Areolar and modifications: 
adipose and adenoid. Mucous or embryonic. Cartilage. 
Bone. Dentine. 

Give the analysis of cementum. 

Cementum has a composition like that of bone. Of organic 
matter, there is about 33%. The remainder consists of in- 
organic substance in the form of the phosphates of lime and 
magnesium, carbonate of lime, sodium chloride and calcium 
fluoride. 



358 HISTOLOGY. 

What is an organic tissue? 

An organic tissue is one in which the structural elements 
are chiefly, if not entirely, composed of living organized sub- 
stances. 

Define lymphatics. Are lymphatics found in the teeth? 

Lymphatics are vessels, with exceedingly delicate walls, the 
function of which is to take up the excess of nutrient fluids 
that have been poured from the capillaries for the nourish- 
ment of the tissues, and return it to the blood stream. They 
also carry the nutrient fluids from the digestive canal. No 
distinct lymphatics have been demonstrated in the teeth. 

What is hemoglobin? 

The coloring matter of the red blood cell, which, when sep- 
arated from the blood, crystallizes into the form of elongated 
prisms. It is a proteid substance having a great affinity for 
oxygen. 

State the kinds of nerve fibers. 

Medullated, or white fibers; non-medullated, gray, or Re- 
mak's fibers. 

Describe the secondary dentine. 

Late in life the pulp cavity becomes more or less filled with 
a dense substance, the structure of which is intermediate 
between dentine and bone. It is a secondary dentine, also 
called osteo-dentine. 

Describe a ganglion. 

Ganglia are bulbous structures situated on the posterior 
nerve roots of the spinal cord, on some of the cranial nerves 
and in the sympathetic system. They consist of a collection 
of nerve cells, each being enclosed in a capsule which is con- 
tinuous with the sheath of the fiber communicating with it. 
The cells are enclosed in a reticulum of connective tissue 
which also contain additional nerve fibers not connected with 
the cell. 



HISTOLOGY. 359 

From what germ layers is epithelium developed? 

Epithelium is developed from the ectoderm, entoderm and 
mesoderm. 

What is histology? 

The term histology is derived from the Greek "histos, " a 
web or tissue, and "logos," a treatise. It is that part of 
science which has for its object the study of tissues. 

What is protoplasm? 

Protoplasm is a proteid substance, containing, in addition, 
some inorganic substances, viz. : phosphorus, calcium. Struc- 
turally it consists of a reticulum, the spongioplasm, in the 
meshes of which is contained a clear semi-fluid substance, the 
hyaloplasm. 

What is a cell? 

A cell is a structural element. It consists of a nucleated 
mass of protoplasm endowed with the properties of life — 
growth, metabolism, reproduction, motion and irritability. 

What is the peridental membrane? 

It is that part of the alveolar periosteum which is redupli- 
cated upon the root of the tooth for the purpose of binding 
the tooth in the socket, producing the cementum, and of sup- 
porting blood-vessels. 

Give analysis of dentine and enamel. 

Dentine contains about 28% of animal matter and 72% 
of earthy matter. Enamel contains but about 4% of animal 
matter. The earthy matter in both consists of the phosphates 
of calcium and magnesium, carbonate and fluoride of calcium. 

What is a tooth germ? 

The structure consisting of embryonal tissues from which 
the tooth is developed. 

How is bone developed? 

(1) In cartilage, where the substitution of calcified sub- 



360 HISTOLOGY. 

stance is effected by the osteoblasts. (2) In fibrous tissue, 
by the deposit of calcified substance upon the bundles of 
fibrous tissue. (3) From the periosteum, by an ingrowth of 
periosteal buds. This variety also substitutes cartilage, but 
differs from the enchondronal in that it grows from the 
surface. 

What is epithelium? 

Epithelium is an elementary tissue found covering surfaces 
and lining cavities. The cellular element exceeds the inter- 
cellular in amount, the latter consisting of but a small quan- 
tity of intercellular cement substance. 

Of what is each of the following composed: (a) the 
hair, (b) the nails, (c) the enamel of the teeth? 

The hair is a modification of the epithelium of the epider- 
mis ; the nails are a very highly developed part of the stratum 
lucidum of the epidermis. The enamel of the teeth is a 
product of the epithelium of the oral cavity. 

Describe the Haversian system. 

A Haversian system occurs in compact bone and consists 
of a system of channels through which the nutrient fluids 
pass. It consists of the following: a centrally placed canal, 
the Haversian canal, which is surrounded by concentric layers 
or plates of bone, the lamellae. Between the plates of bone 
are irregular clefts, the lacunae, which communicate with 
each other and with the Haversian canal by means of radially 
placed canals — 'the canaliculi. 

What is periosteum? Of what tissues is it formed? 

A membrane which, as its name indicates, invests the bone 
for the purpose of supporting the blood-vessels, and also to 
take part in the growth of bone. It consists of two layers: 
(1) an outer, composed of white fibrous tissue, containing 
numerous blood-vessels; (2) the inner, or osteogenetic layer, 
which is rich in elastic fibers and spindle-shaped cells — osteo- 
genetic cells. 



HISTOLOGY. 361 

Describe the formation of the teeth. 

The teeth are composed of three substances — the enamel, 
the dentine and the cementum. The enamel covers the ex- 
posed part of the tooth, the crown of the tooth. The cemen- 
tum covers the part of the tooth within the alveolus of the 
jaw. The junction of the enamel with the cementum is called 
the neck of the tooth. The bulk of the tooth is made up of 
the dentine, which extends from the root to the crown. Each 
tooth contains a cavity, the pulp cavity, which communicates 
with the exterior through a small aperture at the apex of the 
root, the apical foramen. The cavity contains a soft connec- 
tive tissue — the pulp, rich in vessels and nerves. The fang, 
or root of the tooth has a fibrous investment called the peri- 
dental membrane, or periosteum. 

What is an odontoblast? 

An odontoblast is a modified and specialized connective 
tissue cell, for the production of dentine. 

Where are nerve cells found? Describe their structure 
and functions. 

Nerve cells exist in the gray matter of the cerebrum, cere- 
bellum, spinal cord and the posterior nerve root ganglia, in 
the sympathetic nervous system, and in the medullary por- 
tion of the supra-renal capsules, according to some authori- 
ties. A nerve cell consists of a cell body — a large nucleated 
mass of protoplasm having prolongations or poles, and usually 
containing a nucleolus. Nerve cells are classified according 
to the number of processes, as unipolar, bipolar and multi- 
polar. Each nerve cell is the point at which a nerve fiber 
originates in one of the protoplasmic processes, known as the 
axis cylinder process. The other processes when present 
are branched, therefore are called dendrites. The function 
of nerve cells is to generate nervous impulses. 

Describe the structure of a salivary gland. 

A salivary gland is a tubulo-racemose gland. It is in- 



362 HISTOLOGY. 

vested with a fibrous tissue capsule which sends trabecular 
into the substance of the gland to divide it into lobes; these 
in turn are subdivided into lobules. Each lobule consists of 
a collection of secreting units, the acini, which are composed 
of glandular epithelium resting upon a basement membrane. 
The secretion leaves the gland through its ducts, named ac- 
cording to their position in the gland. The interlobular ducts 
between the lobules, the intralobular ducts within the lobules, 
and the intermediate ducts leading from the acini to the in- 
tralobular ducts. Acini may be of the serous type, the cells 
of which are granular and stain deeply ; or mucous, the cells 
being clear and staining faintly. 

What tooth germ first appears and at what period? 

Of the temporary teeth, the germ for the first molar ap- 
pears in the sixth week of embryonic life. 

Is dentine vascular? Explain. 

Dentine does not contain blood-vessels. It probably re- 
ceives its nourishment indirectly from the vessels of the pulp 
as does the true bone by means of its canaliculi. 

What is connective tissue? 

A tissue of mesodermic origin which is composed of a cel- 
lular and intercellular substance, the latter being predomi- 
nant. The cells vary in shape, being round, spindle-shaped, 
stellate and fusiform. The intercellular substance consists of 
fibres and a matrix which vary in their characteristics in 
various kinds of connective tissue. 

Where does cementum form the thickest? 

At the apex of the fang of the tooth. 

Mention the structures contained in a cell. 

A typical cell contains a cell wall or membrane, cell con- 
tents or protoplasm, miclear membrane, nucleus, nucleolus. 
Some cells contain merely the protoplasm and the nucleus. 



HISTOLOGY. 363 

What are the primary germ layers? 

The ectoderm or epiblast, mesoderm or mesoblast, entoderm 
or hypoblast. 

Describe (a) mucous tissue, (b) white fibrous tissue, 
(c) elastic tissue. 

(a) Mucous tissue is a transparent, jelly-like tissue. Micro- 
scopically it is composed of stellate cells arranged in a homo- 
geneous semi-fluid matrix. 

(b) White fibrous tissue consists of delicate white fibers. 
It may be dense, as in tendons, or loose, as in areolar tissue. 
The fibers do not branch. On boiling fibrous tissue it yields 
gelatin. 

(c) Elastic tissue consists of yellow, highly refractile fibers 
which branch freely and have a great tendency to curl at the 
free ends. The fibers are very elastic, and when boiled yield 
elastin. 

Describe two kinds of bone development. 

In enchondronal bone, hyaline cartilage becomes trans- 
formed into osseous tissue. First the cartilage cells multiply 
and become arranged in vertical rows, particularly at the 
epiphyses, and the substance between the cells becomes the 
seat of a deposit of lime salts. In order that the marrow 
cavity and the Haversian canals or spaces be formed, certain 
cells called osteoclasts absorb some of the osseous tissue. In 
long bones, ossification also takes place from the periosteum 
by periosteal buds growing into the cartilage. 

Intra-membranous bone develops in fibrous tissue. The 
bundles of fibres become calcified by the deposit of lime salts 
upon them by the osteoblasts. This usually takes place in a 
manner radiating from a center of ossification. 



*& 



Describe osteoblast, osteoclast. 

An osteoblast is a bone-making connective tissue cell. An 
osteoclast is a cell which absorbs the calcified substance of 
bonv structures. 



364 HISTOLOGY. 

State the difference between compact bone and spongy 
bone. 

Compact bone is densely made up, being composed of layers 
of calcified matrix, called lamellae. It contains Haversian 
canals, with concentric lamellae, between the Haversian sys- 
tems — interstitial lamellae ; lamellae concentric with the periph- 
ery of the bone ; and, if a long bone, perimedullary lamellae. 
Spongy bone is loosely constructed, being composed of an in- 
terlacement of calcified septa forming spaces called Haversian 
spaces. 

What tissue binds together the voluntary muscle fibers? 

Extensions from the connective tissue covering of the 
muscles, called the endomysium. 

What is the sarcolemma? 

The delicate sheath investing the muscle fiber of striated 
voluntary muscle. 

Define neuro*epithelium and state where it is found? 

Neuro-epithelium is of ectodermic origin, and consists of 
modified epithelial cells situated at the terminal of nerves of 
special sense for the purpose of receiving impulses. 

Describe the axis cylinder, the medullary substance, the 
neurilemma. 

These are parts of a so-called medullated nerve fibre. The 
axis cylinder is the essential part; it begins at the origin of 
the nerve fiber in the cell and continues to the termination 
of the fiber. It occupies a central position in the fiber and 
appears to be made up of delicate fibrillae, the primitive 
fibrillae. It is said to have a delicate sheath, the axilemma. 
The medullary substance is the substance which invests the 
axis cylinder of medullated fibers. It is known as the "white 
substance of Schwann." It is of a fatty nature and is re- 
garded as serving to insulate the axis cylinder. It is not con- 
tinuous, being interrupted at points called the "nodes of Ran- 
vier. " The neurilemma is the primitive sheath forming the 



HISTOLOGY. 365 

covering of the nerve fiber. It is a structureless, transparent 
membrane beneath which are situated nuclei, surrounded by 
a small amount of protoplasm forming the nerve corpuscles. 

From what layer of the embryo is the vascular system 
developed? 

From the mesoderm. 

Where does calcification of a tooth begin? 

Calcification of the enamel begins at that part nearest the 
papilla. In the dentine, it begins at the periphery of the 
papilla. 

What tissues are derived from the mesoblast? 

All forms of connective tissue, muscular tissue, endothelium 
of the blood and lymph vessels, pericardium, endocardium, 
pleura, peritoneum, spleen, kidney and ureter, testicle and 
ducts, ovary and Fallopian tubes, uterus and vagina. 

Describe the cellular elements and the fluid portion of 
the blood. 

The cellular elements of the blood are the erythrocytes, or 
red blood-cells, and the leucocytes, or white blood-cells. The 
fluid portion is the plasma, or liquor sanguinis, in which the 
cells are suspended. The red blood-cells are of a greenish- 
yellow cast, but when massed together give the red appear- 
ance to the blood. In distinction to the white blood-cells, 
they are not nucleated as the latter are. They occui» in the 
proportion of 500 red to 1 white. White blood corpuscles 
have the power of amoeboid motion. There are several vari- 
eties of leucocytes named according to the character of the 
nucleus and affinity for stains. The most important are the 
polynuclear leucocytes occurring in about 70% of all the leu- 
cocytes. The fluid part of the blood is a somewhat sticky, 
clammy liquid. It contains the factors of fibrin, namely, 
fibrinogen and fibrin ferment, which are the agencies active 
in the clotting' of blood. 



366 HISTOLOGY. 

Describe the dental ridge. 

It consists of a linear thickening of the primitive oral epi- 
thelium from which the enamel germ is later formed. 

What layers of the embryo contribute to the develop- 
ment of the teeth? 

The ectoderm and the mesoderm. 

Which of the permanent teeth first calcify? 

The first molars (sixth month) in the upper jaw. A little 
later in the lower jaw. 

What is the origin of the cementum? 

Cementum has its derivation in the alveolar periosteum. 

What is a phagocyte? 

It is a cell possessing the power of amoeboid movement, by 
means of which it takes in and incorporates particles with its 
own substance. It is usually a leucocyte. 

What are leucocytes? 

The colorless corpuscles of the blood, usually known as 
white corpuscles. 

How many kinds of bone tissue are there? 

Bone is usually divided into two varieties: (1) compact or 
dense, and (2) cancellated or spongy. 

What is tissue? 

Tissue is an arrangement of structural elements and con- 
sists of a cellular and an intercellular substance. When the 
structural elements are of the same type, it is known as a 
simple or elementary tissue; when of more than one type, it 
is a complex tissue. 

What is the blastoderm? 

The blastoderm is a sac-like arrangement of embryonal cells 
formed by the cleavage of the ovum. It consists of three 
layers : ectoderm, mesoderm and entoderm ; from these all of 
the tissues of the animal body are developed. 



HISTOLOGY. 367 

How do cells receive their nourishment? 

Cells are nourished by means of the nutrient blood plasma 
which escapes from the walls of the ultimate capillaries in the 
tissue. The cells are literally bathed in the blood plasma. 

What is embryology? 

That part of science which treats of the development of 
the embryo is known as embryology. 

Describe the development of blood vessels and lym- 
phatics. 

Having a mesodermic origin, the blood and lymph vessels 
first appear as "cords" of cells which later become hollow to 
form tubes. The innermost cells become distinctly flattened 
to form the endothelial lining. The first blood-vessels have 
their beginning outside the body of the embryo, in the 
yolk-sac. 

Describe the muscular tissue. 

Muscular tissue is of mesodermic origin and consists prin- 
cipally of elongated cells (fibrous cells) which have the in- 
herent power of contracting. The muscle fibers contain nuclei 
and, sometimes, that which corresponds to a cell wall, the 
sarcolemma. Voluntary and cardiac muscles are striated, due 
to the arrangement of alternate light and dark discs. Non- 
striated muscle is involuntary. Microscopically, they may be 
differentiated as follows : 

Striated. Non-Striated. Cardiac. 

Fibers striated trans- No striations. vStriated longitudinally and 

versely. transversely. 

Has sarcolemma. Hyaline sheath. No sarcolemma. 

Nucleus beneath sar- Nucleus in cen- Nucleus oval and in center. 

colemma. ter. 

Fibers do not branch, Fibers short. 

except in the tongue. Fibers branch freely. 



368 HISTOLOGY. 

To what class of tissues do the teeth belong? 

With the exception of the enamel, which is a product of 
epithelium, the teeth belong to the connective-tissue group. 

From what is the six=year molar derived? 

The enamel germ of the first permanent molar appears at 
the extremity of the dental ridge after the manner of a tem- 
porary tooth ; it appears about a week before the budding of 
the germs of the temporary teeth. 

Give the principal tissues of the animal body. 

Blood and lymph, epithelium, connective, muscular and 
nervous. The blood and lymph are often classified with the 
connective tissue. 

State the functions of epithelium. 

Protective, secretory, absorptive, to permit exchange of 
gases, to produce motion (ciliary), for the reduction of fric- 
tion (endothelium), and for the reception of nervous impulses. 

What are the soft fibers of Tomes? 

Prolongations of the odontoblasts into the dentinal tubules 
are known as "fibers of Tomes." 

State the size, shape and structure of a human red 
blood corpuscle. 

The red blood corpuscles are disc-shaped, biconcave, and 
are 1-3200 of an inch in diameter. They are not nucleated; 
and, though they probably have a delicate cell wall, none can 
be demonstrated. The cell contains a substance, hemoglobin, 
which gives the color to the cell. 

Describe the structure of arteries. 

The medium-sized arteries are composed of three coats or 
tunics. The tunica intima (inner), consisting of an endothe- 
lial lining, resting upon a sub-endothelial layer of loose con- 
nective tissue, which is separated from the middle coat by a 
layer of elastic tissue, lamina elastica interna. The tunica 
media (middle) is a muscular tunic and consists of a layer of 



HISTOLOGY. 369 

involuntary (non-striated) muscle fibers circularly arranged. 
The tunica adventitia (outer) consists of an admixture of 
white fibrous and yellow elastic connective tissues. This tunic 
contains small vessels which nourish the artery, called vasa 
vasurum. 

To what tissue does dentine belong? 

To the connective tissue of the dense variety. 

What is bioplasm? 

The living substance of the cell. The term is often used 
synonymously with protoplasm. 

Mention the varieties of epithelium. 

Squamous, columnar, ciliated, glandular, transitional, pig- 
mented, and neuro-epithelium. The first three may occur in 
a single layer, when it is named "simple;" or, in several 
layers, when it is called "stratified." 

Describe the more minute structures which evolve the 
sense of taste. 

On the dorsum and sides of the tongue, particularly the 
former, are elevations of the mucous membrane in the form 
of papillae. 

A few of the papillae (8-12), situated on the posterior part 
of the dorsum of the tongue, are surrounded by a furrow, 
hence called the circumvallate papilla?. They are arranged 
in the form of the letter "V," the apex being directed pos- 
teriorly. These papillae usually bear secondary papillae. Em- 
bedded in the stratified squamous epithelium on the surface 
of the papillae are oval bodies composed of modified epithelial 
cells arranged "like the staves of a barrel." These are the 
taste buds which are communicant with the terminals of the 
gustatory nerve. 

The fungiform papillae, more numerous than the circumval- 
late, receive filaments of the nerves of taste; but there are 
fewer of the "special endings" than in the circumvallate. 
Secondary papillae also occur on the fungiform papillae. 
24 



370 HISTOLOGY. 

The largest number of the papillae is of the conical or fili- 
form variety, consisting of a conical elevation of connective 
tissue covered with epithelium. They carry the terminals of 
the nerve fibres to the periphery. 

Describe the cell structure of articular cartilage. 

The articular surfaces are covered with hyaline cartilage, 
the distinguishing feature of which is the translucency of its 
matrix. The matrix, which presents a homogeneous appear- 
ance, contains many cartilage cells which occupy and com- 
pletely fill spaces called lacunae. Sometimes, two or more cells 
occur in a single lacuna. The cells are distinctly nucleated; 
the youngest are spindle-shaped and occupy a position next 
to the perichondrium, while the oldest cells are deeper and 
are irregularly rounded, having a tendency to become an- 
gulated. 

How does a mucous membrane differ from a serous 
membrane? 

Mucous membranes line all cavities communicating directly 
or indirectly with the atmosphere. They consist of an epi- 
thelial covering, the variety of which varies with the location, 
resting upon a connective tissue base — the tunica propria. 
Extensions of the epithelium into the connective tissue be- 
neath, arranged in the form of tubes or sacs (usually the 
latter) which secrete mucous for the purpose of moistening 
the surface of the membrane, form the mucous glands. 

Serous membranes are found lining closed sacs. They con- 
sist of a single layer of endothelial cells resting upon a con- 
nective tissue membrane. Minute openings, stomata, existing 
between some of the cells, communicate with lymph capil- 
laries. The fluid found on the surface of serous membranes 
comes from the lymph channels. Serous saes may be re- 
garded as large lymph spaces. 

Describe the pericemental membrane. Give its origin 
and function. 

The pericemental membrane is the fibrous tissue investment 



HISTOLOGY. 371 

which covers the root of the tooth. The fibres composing it- 
run, for the most part, transversely. Elastic fibres are not- 
ably absent. It has its origin in the outer layer of the dental 
sac. This membrane serves to hold the tooth in the alveolus 
and to furnish the nutrition to the cementum through the 
blood-vessels it carries. Acting as a cushion, it seems to 
diminish shock during mastication. 

Differentiate between osteoclasts and cementoblasts. 

Osteoclasts are connective tissue cells found in bone-form- 
ing tissue. It is by their agency, the absorption of calcified 
matrix, that the Haversian canals and spaces are formed. 

Cementoblasts are also connective tissue cells, but their 
function is that of depositing lime salts in the matrix of the 
cementum. 

Describe the process of dental calcification. 

At about the end of the fourth month the enamel of the 
temporary teeth is formed. From the extremity of the enamel 
cells, next to the papilla?, develops a tuft-like projection, 
which becomes calcified, forming an enamel prism. The pro- 
cess of calcification proceeds, therefore, from within outward. 

At about the same period the deposit of dentine on the 
sides and apex of the dental papillae begins, and therefore 
proceeds from without inward. Calcification of the dentine 
is not complete, for the areas known as interglobular spaces 
are not calcified, nor are the processes of the odontoblasts — 
the dentinal fibres. 

Describe the structure, blood supply and nerves of the 
pulp. 

The pulp consists of embryonic connective tissue which is 
composed of stellate cells arranged in a semifluid, transparent 
matrix. 

Next to the wall of the pulp-canal are columnar-shaped 
cells, the odontoblasts, processes of which enter the dentine 
as the dentinal fibrils. 

The pulp is well supplied with blood-vessels and nerves 



372 HISTOLOGY. 

which enter at the apical foramen. After entering the pulp- 
canal they break up to form plexuses which terminate in the 
layer of odontoblasts. 

The function of the pulp is that of furnishing nutrition to 
the dentine and enamel. Due to the rich 'nerve supply, the 
pulp is very sensitive. 

From what is the mesoblast derived? 

The mesoblast has its origin partly in the epiblast and 
partly in the hypoblast, though chiefly the latter. 

What two tissues are formed by the dental papilla? 

The dentine which is deposited at the periphery of the 
papilla ; and the pulp, which is that portion of the papilla 
remaining after dentine has been formed. 

Describe separately the calcified products of the con- 
nective tissue. 

Bone may be considered to be of two kinds: compact or 
dense, and cancellated or spongy. 

Compact bone consists of a dense matrix containing lime 
salts, which matrix contains numerous channels for the pas- 
sage of nutrient vessels and fluids, also clefts or spaces, 
containing bone cells. The largest channels (1-500 inch in 
diameter), called "Haversian Canals," run parallel with the 
long axis of the bone and form anastomoses with one another. 
The canals are surrounded with concentric layers of osseous 
matrix : Haversian lamella, between which are small spaces, 
the lacuna, which in recent bone contain bone cells. Radi- 
ating from the Haversian canals to the lacunae, are minute 
channels which convey lymph. They are the canaliculi. The 
above-named structures form what is termed a " Haversion 
System." Between the systems, which are circular, inter- 
stitial lamella occur, thus filling the space that otherwise 
would exist. 

Lamellae also occur concentrically with the periphery of the 
shaft of the bone, the circumferential lamella, and with the 
medullary canal, the perimeclullary lamella. 



HISTOLOGY. 373 

Spongy bone does not contain Haversian systems, and, 
therefore, no Haversian canals. There are, however, as the 
name implies, numerous spaces in the matrix ; they are 
known as "Haversian spaces." 

Dentine consists of a calcified matrix in which, extending 
through the entire thickness of the matrix, are seen the den- 
tinal tubules which terminate in irregular clefts at the junc- 
tion of the dentine with the enamel and cementum. These 
clefts are known as the interglobular spaces. The part of the 
matrix immediately surrounding the tubules forms the den- 
tinal sheaths. The tubules contain processes of cells at the 
periphery of the dentine — the dentinal fibres. 

Cementum resembles very closely the structure of bone. 
Near the apex of the root, where the cementum is thickest, 
Haversian canals may sometimes exist, though usually they 
are not present. 

What tissue is the origin of the enamel? What are 
ameloblasts? 

Enamel originates in the oral epithelium. 

Ameloblasts are the enamel-producing cells. They are dis- 
tinctly columnar in shape and occupy a position in the enamel 
organ nearest the dentine. 

Describe the development of the dental papilla? 

The dental papilla is of connective-tissue origin. Its posi- 
tion is first evidenced by a proliferation and condensation 
of the mesodermic elements. This collection of cells soon 
assumes the shape of a cone, its apex pointing towards, and 
later invaginated by the enamel organ. The apex and sides 
of the conical mass become surrounded by columnar cells — the 
odontoblasts, which are the producing agents of the dentine. 

By what cells, and under what conditions does resorp- 
tion occur? 

Cells which are endowed with the function of breaking 



374 HISTOLOGY. 

down osseous tissue, namely, the osteoclasts, are active in the 
process of resorption. Resorption takes place previous to 
the eruption of the permanent teeth and is stimulated by the 
increased blood supply and pressure of the unerupted per- 
manent teeth. 

Describe Meckel's cartilage. 

Meckel's cartilage is a rod of cartilage which appears in 
the mandibular arch and partly enters into the formation of 
the inferior maxilla, namely, the extremity at the symphysis 
and the proximal extremity, which persists with a covering 
of fibrous tissue to form the internal lateral ligament of the 
jaw. The greater part of Meckel's cartilage disappears at 
about the sixth month of foetal life. 

Name the specialized cell for each particular structure 
of the teeth. 

The specialized cell of the enamel is the ameloblast. That 
for the dentine is the odontoblast. For the eementuni, the 
cementoblast. 

What are interglobular spaces? 

At the junction of the dentine with the enamel and eemen- 
tuni arc areas which are imperfectly calcified; they are some- 
what globular in shape, hence called interglobular spaces. 

Describe the dental follicle. 

The dental follicle is the result of the condensation of the 
mesodermic cells surrounding the papilla, which later extends 
upward so as to surround the entire rudimentary tooth. 

Why should there be a difference between the struc- 
ture of dentine and cementum? 

Dentine is a product of embryonic connective tissue through 
the specialized cell, the odontoblast; while the cementum is 
produced by the connective tissue cells of the alveolar perios- 
teum, the cementoblasts ; therefore, the structure of the cemen- 
tum resembles that of bone. 



HISTOLOGY. 375 

Describe the enamel organ and the cells that form 
enamel. 

The enamel organ has its origin in a down-growth of the 
oral ectodermic tissue. When fully developed it consists of 
a sac, the lower margin of which is indented by reason of its 
contact with the underlying papilla ; structurally, it consists 
of three layers of cells. An upper, continuous with the super- 
ficial cells of the ectoderm, a middle layer of stellate cells, 
and an inferior layer of distinctly columnar-shaped cells. 
The last-named cells are the cells which produce enamel. The 
enamel cells, when active in the production of enamel, ex- 
hibit, at their lower extremity (toward the papilla), a tuft of 
short processes. It is along these processes that the deposit 
of the enamel takes place. 

What is the primitive dental groove? (b) What organ 
of the teeth is developed from it? 

A longitudinal furrow, seen on the surface of the ectoder- 
mic tissue, which marks the point of attachment of the dental 
ridge lying immediately beneath, (b) The enamel organ. 

Describe the dental fibrillae; with what are they con= 
nected, and where do they terminate? 

The dental fibrillse occupy the dental tubules and extend 
throughout their length. The fibrils are protoplasmic exten- 
sions of the odontoblasts terminating at the periphery of the 
dentine. 

Describe the stratum granulosm. 

At the periphery of the dentine, the substance is not com- 
pletely calcified. As a result there are small irregular clefts, 
the interglobular spaces. This layer of the dentine is known 
as the granular layer. 

What is Neuman's Sheath? 

The part -of the dentinal matrix immediately surrounding 
the dentinal tubules constitutes the so-called dentinal sheaths, 
or sheaths of Neuman. 



376 HISTOLOGY. 

What is calcification? 

Calcification is the process by means of which tissue may 
become infiltrated with lime salts. It is a product of the cel- 
lular element of the tissue that is deposited in the inter- 
cellular substance of which it becomes a part. Calcification 
usually is effected in layers, and, in the instance of bone and 
cementum, well-defined lamellae are formed. 

Mention the methods of distribution of cells in the 
various tissues. 

On surfaces (epithelium and endothelium). 
Suspended in fluid (blood and lymph). 
Interstitially, in a matrix (connective tissues). 

What is perichondrium? 

A fibrous investment covering cartilage. It consists of an 
outer fibrous, the vascular layer; an inner chondrogenetic 
layer, composed of spindle-shaped, cartilage-forming cells. 

Name the varieties of cartilage. 

White fibro-cartilage, yellow elastic cartilage, hyaline car- 
tilage. 

Which variety of cartilage does not have a perichon- 
drium? 

White fibro-cartilage. 

How may all tissues be classified? 

According to (1) their ancestry, (2) function, (3) morpho- 
logical character. 

Explain the difference between epithelium and endo- 
thelium. 

Epithelium and endothelium occur on surfaces, but the 
location, the function and the arrangement varies. 



HISTOLOGY. 



377 



Epithelium. 

Ectoderm 



Ancestry 



Function 



Morphological 
Character 



Entoderm 
Mesoderm (rarely) 

Protective 

Secretory 

Absorptive 

Permit exchange of gases 

Motion 

Nervous 

Simple and 

Stratified 

Squamous 

Columnar and 

Polyhedral-shaped cells 



Endothelium. 



Mesoderm 



Reduction of friction 



Always in a single 
layer 



Always squamous. 
What is meant by the ancestry of a tissue? 

Its origin in the blastoderm. 

What is the function of connective tissue? 

Connective tissue enters into the formation of the struc- 
ture to make a supporting framework; especially where great 
strength is required. Blood-vessels, nerves and lymphatics 
are always carried in connective tissue. 

What is the structure of capillaries? 

Capillaries are the ultimate radicles of the vascular (arte- 
rial) system, and consist of a continuation of the lining of 
those vessels ; being made of a single layer of endothelial cells, 
united by a small amount of intercellular cement substance. 

What cells form dentine? 

The odontoblasts. 



PHYSIOLOGY. 



Give the sources of saliva and its chemical functions 
and otherwise. 

Saliva is the secretion of the parotid, submaxillary and sub- 
lingual glands. It contains a ferment, ptyalin, which con- 
verts starch into maltose. The saliva facilitates speech by 
moistening the mucous membrane of the mouth ; and on ac- 
count of its contained mucin, facilitates deglutition by lubri- 
cating the bolus of food. By dissolving some of the solids in 
the food it allows them to be tasted. 

Where and how are the products of digestion finally 
incorporated into the tissues? 

The digested food is absorbed mainly by the villi of the 
small intestines. The water, soluble salts, glucose and pep- 
tones are passed through the columnar epithelium of the villi 
into the capillaries. These capillaries are radicals of the 
portal vein, and through this vein the products are carried 
to the liver. The blood of the liver passes out through the 
hepatic vein into the inferior vena cava and thus into the 
general circulation. The peptones during their passage 
through the columnar epithelium are converted into albu- 
mens and globulins. The digested fat passes through the 
columnar epithelium of the villi into the central lymphatic 
vessel or lacteal. These lacteals carry the absorbed fats to 
the thoracic duct, which in turn empties them into the left 
subclavian vein, and thus into the general circulation. 

Describe the physiological process that takes place in 
the kidneys. 

The kidneys are compound tubular glands secreting urine. 

(379) 



380 PHYSIOLOGY. 

The tubules commence in the Malpighian corpuscles in the 
cortex. After leaving these the tubules become convoluted, 
then pass down as the loops of Henle, again become convo- 
luted, and finally empty into the collecting tubules. The con- 
voluted portions are lined with rodded epithelium, and it is 
by these cells that the urea is picked out of the blood. All 
the substances found in the urine are waste products circu- 
lating in the blood, and these the epithelium picks out from 
the blood. The one exception to this is hippuric acid, which 
is formed by the kidney cells. 

Describe the stomach and its secretions. 

The stomach is the ovoid dilatation of the gastro-intestinal 
tract; and is a muscular sac lined inside with mucous mem- 
brane, and outside with a serous membrane. The food enters 
from the oesophagus at the cardiac orifice, and passes out into 
the duodenum at the pyloric orifice. The stomach has two 
curvatures, the upper, or lesser curvature, and the lower, or 
greater curvature. That portion of the stomach lying to- 
wards the spleen and forming a part of the greater curva- 
ture, is called the fundus. The stomach has four coats: 
serous, or outer; muscular, of which there are three distinct 
layers, circular, longitudinal and oblique; submucous; and 
mucous, imbedded in which we have the tubular glands that 
secrete the gastric juice. 

The gastric juice is a limpid, acid secretion, specific grav- 
ity 1005, containing salts, hydrochloric acid (.2%), and two 
ferments, pepsin and rennin. About ten pints are secreted 
daily. 

How is the skin kept moist and the cuticle pliable? 

The skin is kept moist by the sweat, and the cuticle pliable 
by the sebaceous secretion. 

What are the sources of heat in the body? 

Heat is produced in the body by katabolism, principally in 
the muscular and glandular tissues. 



PHYSIOLOGY. 381 

Trace the circulation of the blood once around its course 
beginning at the right auricle. 

The blood enters the right auricle from the superior and 
inferior vena-cavas, thence through the right auriculo-ven- 
tricular or tricuspid valve into the right ventricle, past the 
pulmonary semilunar valve into the pulmonary artery to the 
capillaries of the lungs; from the lungs it is carried back 
through the pulmonary veins to the left auricle, past the left 
auriculo-ventricular or mitral valve into the left ventricle, 
through the aortic semilunar valve into the aorta and its 
branches to the capillaries of systemic circulation, and from 
these it is carried back to the heart by the systemic veins. 

What is waste, and by what organs is it eliminated 
from the system? 

Waste is the product of metabolism of no further use to the 
organism. Waste is eliminated by the lungs, kidneys, skin 
and intestines. 

In what various ways is the loss by waste restored? 

By food, water and respiration ; the blood acting as a 
medium of exchange. 

Describe the mechanical process by which the blood re= 
ceives oxygen. 

The blood receives its oxygen in the lungs where the capil- 
laries containing. venous blood are separated from the oxygen 
of the air by a single layer of pavement epithelium. Three 
factors are concerned in the absorption of oxygen ; mechan- 
ical law of pressure of gases, chemical affinity between hemo- 
globin and oxygen, and the vital activity of the epithelium 
of the air-vessels. 

By what special fluid is nourishment to the tissues de= 
livered, and how? 

By the circulating blood, by osmosis through the capillary 
walls. 



382 PHYSIOLOGY. 

Describe fully the preparation of pabulum for the blood. 

The starches are converted by ptyalin of saliva and amy- 
lopsin of pancreatic juice into maltose. 

Maltose and cane sugar are converted into glucose by the 
invertin of succus entericus. Caseinogen is converted into 
casein by the rennin of gastric juice, and the milk-curdling 
ferment of pancreatic juice. 

The proteids are changed into proteoses and peptones by 
the pepsin of gastric juice and the trypsin of pancreatic juice. 
Enterokinase of the succus entericus energizes the trypsin. 

The fats are split into fatty acids and glycerine, saponi- 
fied and emulsified by the steapsin of pancreatic juice and 
by the bile. 

The digested food is then absorbed by the villi of the small 
intestines. The fats are carried by lacteals to the thoracic 
duct; and the glucose, water, soluble salts and peptones are 
carried by the portal vein to the liver, the peptones being 
changed into native proteids while passing through the epi- 
thelium of the villi. 

What is the medulla oblongata? Give a short de- 
scription. 

The medulla oblongata is that portion of the central nerv- 
ous system between the upper end of the spinal cord and the 
lower boundary of the pons varolii. 

It is pyramidal in shape with the base upward, and is 
about one inch long, three-fourths of an inch wide and half 
an inch thick. Anteriorly is seen the anterior median fissure, 
the olivary bodies, and the anterior pyramids. 

The posterior surface of the medulla forms part of the floor 
of the fourth ventricle, bounded on each side by the diverging 
posterior columns of white matter. Laterally we find emerg- 
ing the cranial nerves from the sixth to the twelfth inclusive. 

In structure we find that it is made up of gray and white 
matter. 

The gray matter is cut up into small masses by the motor 



PHYSIOLOGY. 383 

and sensory decussations. These masses of gray matter form 
the nuclei for most of the cranial nerves. 
Describe the mechanism of the heart. 

The heart is a hollow muscular organ divided into four 
cavities, two on the right side and two on the left. Between 
the two sides there is no communication. The right side re- 
ceives venous blood and forces it into the pulmonary circu- 
lation. The left side receives arterial blood and forces it into 
the general, systemic or greater circulation. The two auricles, 
contracting simultaneously toward the end of ventricular 
diastole, force the blood into the ventricles. The ventricles 
then contract, the auriculo-ventricular valves are closed, and 
the blood is forced into the arteries. The ventricles then 
relax and the blood flows in from the auricles, the auriculo- 
ventricular valves being open. The blood tends also to re- 
gurgitate into the ventricles from the arteries, but is pre- 
vented by the closure of the semilunar valves. The heart has 
been likened to a force-pump, but it is also a suction-pump, 
for during diastole, there is a negative pressure in the ven- 
tricles due to the elasticity of the muscular wall tending to 
produce a vacuum. 

As to the nervous mechanism of the heart, we find in the 
medulla the cardio-inhibitory and the cardio-accelei*ating 
centers. The efferent nerve from the cardio-inhibitory center 
to the heart is the vagus or pneumogastric ; the efferent from 
the cardio-accelerator center is the accelerator branch of the 
sympathetic system. These nerves end in ganglionic masses 
in the heart. 

There is also an efferent nerve from the heart called the 
nervous depressor of Cyon and Ludwig ; when there is danger 
of rupture of the heart from over-pressure, it is irritated 
and carries an impulse to the vasomotor center that depresses 
its tonus and lowers the blood pressure. 

Describe the pancreas, and the character and functions 
of its secretion. 

The pancreas is a tongue-shaped organ about six inches 



384 PHYSIOLOGY. 

long, weighing about two ounces and situated back of the 
stomach. It is sometimes called the abdominal salivary gland. 

The duct enters the duodenum about an inch and a half 
below the pylorus. The bile duct joins with it just before it 
opens into the duodenum. 

The pancreatic juice is a transparent, viscid, alkaline fluid, 
specific gravity 1012. There are about eight ounces secreted 
daily. It contains salts, especially sodium salts and four fer- 
ments. Amylopsin converts starch into maltose. 

Trypsin converts proteids into peptones, and even into 
lower bodies, leucin, tyrosin and arginin. 

Steapsin splits up the fats into fatty acids and glycerine. 
The fatty acids combine with the alkalies present to form 
soap and this aids the emulsification of the rest of the fat. 

There is also a milk-curdling ferment. 

The pancreas has also an internal secretion, as extirpation 
of the organ causes diabetes. 

In what way does the blood lose material? 

By osmosis through the capillary walls into the tissues; 
by excretion from the lungs, skin, kidneys and liver, and by 
osmosis into gastro-intestinal canal, as in the watery stool 
following saline cathartics. 

What is the cerebro=spinal axis, and what is its function? 

The cerebro-spinal axis is that portion of the nervous sys- 
tem consisting of spinal cord, medulla, pons varolii, crura 
cerebri, basal ganglia, cerebrum and cerebellum. Its func- 
tion is to receive afferent impulses and to send out, as the 
result of these, efferent impulses, to keep the body in normal 
condition, and through the cerebrum presides over thought, 
volition and sensation. 

What is the purpose of the lymphatic system and how 
fulfilled? 

The liquid portion of the blood osmoses through the capil- 
lary walls into the tissue. This diluted blood plasma is called 



PHYSIOLOGY. 385 

lymph. It bathes and nourishes the tissue and is carried by 
the lymphatics back to the general circulation through the 
thoracic duct and right lymphatic duct. They also carry 
absorbed material as the fat from the intestines, into the gen- 
eral circulation. 

The secretion of some of the ductless glands is emptied 
into the blood through its lymphatics. The cells formed in 
the lymph glands become leucocytes. 

What chemical exchange is effected in the lungs dur= 
ing respiration? 

Oxygen is absorbed by the blood. Carbon dioxide, nitro- 
gen, water and very small quantities of organic volatile prin- 
ciples are thrown off. 

How is the normal temperature of the human body 
maintained? 

The normal temperature of the body is maintained at 
about 98.4° P., by the proper balancing of heat production 
and heat dissipation. The production and dissipation of heat 
are controlled by the thermotaxic centers of the nervous sys- 
tem. These include the thermolytic, thermogenic and thermo- 
inhibitory centers. 

Describe the process of deglutition and name the glands 
where secretions are an essential aid in the process. 

Deglutition is the act of swallowing or passing of the food 
from the mouth into the stomach. There are in this act three 
stages, buccal, pharyngeal and oesophageal. The first is vol- 
untary, the last two are involuntary. 

The bolus of food is forced by the tongue from the mouth 
into the pharynx, the muscular wall of which contracting 
from above downward forces the bolus into the oesophagus. A 
peristaltic wave of contraction then forces the bolus through 
the oesophagus into the stomach. Thus the deglutition of 
solids is a peristaltic act, But liquids are squirted through 
the pharynx and esophagus with bulb-syringe effect by eon- 
traction of the mylo-hyoid muscle. 
25 



386 PHYSIOLOGY. 

The center of deglutition is in the medulla. It receives 
afferent impulses through the trifacial and glosso-pharyngeal 
nerves, and gives off efferent impulses through the inferior 
maxillary division of the trifacial and glosso-pharyngeal and 
vagus. 

The glands whose secretion aids deglutition are the salivary, 
especially the submaxillary and sublingual ; also the mucous 
"lands of the mucous membrane of the mouth, pharynx and 
oesophagus. 

Name the digestive secretions, mentioning the principal 
action of each upon food. 

Saliva, gastric juice, pancreatic juice, bile and succus en- 
tericus are the digestive secretions. 

Saliva converts starch into maltose. 

Gastric juice converts proteids into peptones, and casein- 
ogen into casein. 

Pancreatic juice converts proteids into peptones, starch 
into maltose, splits up the fats into fatty acids and glycerine, 
and converts caseinogen into casein. 

Bile emulsifies fats and prevents excessive action of bac- 
teria. 

Succus entericus converts maltose and cane sugar into glu- 
cose and energizes the trypsin. 

Give the apparent origin and general distribution of 
the pneumogastric nerve. Mention some of the organs 
whose action it influences. 

The superficial origin of the pneumogastric is from the 
groove on the lateral surface of the medulla between the oli- 
vary and restiform bodies. It is distributed to the pharynx, 
larynx, oesophagus, heart, lungs, stomach, and to the ab- 
dominal sympathetic system. It is the motor nerve to the 
pharynx; motor and sensory to the larynx; motor, sensory 
and respiratory to the lungs; motor, sensory and secretory to 
the stomach; cardie-inhibitory to the heart, and secretory to 
the pancreas, motor and inhibitory to the intestines. 



PHYSIOLOGY. 387 

Describe the liver, its secretion and the function thereof. 

The liver is the largest gland in the body, weighing about 
four pounds, and measuring transversely about twelve inches, 
antero-posteriorly about seven inches, and at its posterior part 
is about three inches thick. 

It is situated principally in the right hypochondriac region, 
but extends through the epigastrium into the left hypochon- 
driac region. 

It is divided by five fissures into five lobes, the largest of 
which is the right lobe. The most important fissure is the 
transverse; for through this the blood enters the liver through 
the portal vein and hepatic artery, and passes out through the 
hepatic vein. The bile also passes out through the hepatic 
duct through this fissure. 

The secretion of the liver is bile. 

Bile is a reddish-yellow, or reddish-green, alkaline, viscid, 
bitter liquid with a specific gravity of about 1020. There are 
about two or two and a half pints secreted daily. 

It contains among other substances bilirubin, biliverdin, 
taurocholate and glycocholate of sodium, cholesterin, mucin 
and inorganic salts. 

The bile neutralizes the acid chyme, precipitating the pep- 
sin ; emulsifies fats, and aids in their absorption ; increases 
peristalsis; it is a slight antiseptic; and contains waste pro- 
ducts thrown off by the liver. 

Mention the nutritive fluids of the body. 

Blood, lymph and chyle. 

What conditions affect the body temperature? 

All conditions affect the body temperature that destroy the 
balance between heat production and heat dissipation. 

Among these you have muscular exercise, digestion, pro- 
longed exposure to extremes of temperature, shock (mental 
or physical), hysteria, drugs (as antipyrin, chloral hydrate 
and atropine), toxins of bacteria, injection of peptones and 
ptomaines, irritation of any one of the thermotaxic centers. 



388 PHYSIOLOGY. 

Give the composition of the pancreatic secretion. 

According to Halliburton you have 97.6% of water; 1.8% 
of organic matter of which the most important are the fer- 
ments; and .6% inorganic salts, among which are sodium 
chloride, sodium phosphate and potassium chloride. 

Give the properties of pancreatic juice, and state its re= 
action. Where does the pancreatic juice enter the in- 
testine. 

The pancreatic juice is a colorless, transparent, viscid, alka- 
line fluid with a specific gravity of 1012. It contains four 
ferments; trypsin, amylopsin, steapsin and a milk-curdling 
ferment. 

The pancreatic juice enters the intestine through an open- 
ing in the posterior surface of the duodenum about its middle. 

Give the composition of blood, and state the use of each 
component part. 

The blood is composed of sixty parts of plasma or liquor 
sanguinis and forty parts of corpuscles. 

The plasma is the liquid portion and contains about ten 
per cent, of solid matter, of which four-fifths are proteids. 
The solid matter is made up of serum albumen, serum glob- 
ulin, fibrinogen, salts, glucose, fats and extractives. 

There are two kinds of corpuscles, red and white. 

The red corpuscles are the more numerous, the proportion 
being seven hundred reds to one white. The principal sub- 
stance in the red corpuscle is the hemoglobin. 

The white corpuscles have amoeboid movement, and have 
a phagocytic action. By their disintegration fibrin ferment 
is formed. 

The red corpuscles carry the oxygen to the tissues. 

The fibrinogen clots after leaving the vessel and thus stops 
bleeding. 

The plasma carries the absorbed food to the tissues and 
the waste products to the excretory organs. 



PHYSIOLOGY. 389 

The blood also keeps the various parts of the body at a 
fixed temperature. 

The function of the blood-plates is not known. 

State the difference between the vasoconstrictor nerves 
and the vaso=dilator nerves. 

The vaso-constrictors, when stimulated, decrease the caliber 
of the arterioles by causing a contraction of the muscular 
fibres in the middle coat of the vessels. 

The vaso-dilators, when stimulated, increase the caliber of 
the arterioles by inhibiting or decreasing the tonus of the 
local vaso-motor ganglia in the muscular wall. 

Define voluntary muscle; involuntary muscle. Give ex= 
ample of each. 

The voluntary muscles are those under the control of the 
will, and are transversely striated. The biceps is an example 
of a voluntary muscle. 

The involuntary muscles are those not under the control of 
the will, and are not transversely striated. The muscular 
coat of the arteries is an example. 

State the function of the hypoglossal or sublingual nerve. 

It is the motor nerve of the tongue and the muscles con- 
nected with the hyoid bone. 

What special centers exist in the medulla oblongata? 

Deglutition, salivation, mastication, vomiting, diabetic, car- 
dio-inhibitory, cardio-accelerator, vaso-motor and respiratory. 

What is the function of the cerebrum? 

The cerebrum is the center of volition, sensation and 
ideation. 

What is the difference between proteid and amyloid 
foods? 

Proteids contain carbon, hydrogen, oxygen, nitrogen and 
sometimes phosphorus. 

The amyloid foods contain carbon, hydrogen and oxygen ; 



390 PHYSIOLOGY. 

the last two elements in the proportion to form water; and 
in the molecule, six atoms of carbon or a multiple of six. 

The body can form amyloids from proteids, but cannot 
form proteids from amyloids. 

What is meant by flexion and extension of muscle? 

By flexion is meant the shortening or contraction of the 
muscle. 

The relaxation or lengthening of the muscle is called 
extension. 

Give the location of the stomach. State the work ac= 
complished by the stomach. 

It is situated in the front part of the upper abdomen in 
the epigastric region with its pyloric end a little below and 
to the right of the xiphoid cartilage, and its fundus project- 
ing over into the left hypochondrium. 

The stomach changes the proteids into peptones, curdles 
milk, and liquefies fats. 

Describe the stomach and its movements during 
digestion. 

The stomach is an irregularly ovoid, muscular sac, lined 
inside with mucous membrane, and outside with serous mem- 
brane. It is the dilated portion of the gastro-intestinal tract 
between the oesophagus and small intestine. The stomach 
holds, when full, about three pints. It has two openings, the 
cardiac, through which the food enters the stomach, and the 
pyloric, through which the food leaves the stomach. It has 
two curvatures, the upper or lesser and the lower or greater. 
The portion of the greater curvature lying toward the spleen 
is called the fundus. 

When the food reaches the stomach the two orifices close 
tightly like sphincters ; the muscular wall also contracts down 
upon the food, and by means of the three muscular layers 
keeps the food in constant motion. Thus it brings fresh 
portions constantly to the surface to be acted upon by the 



PHYSIOLOGY. 391 

gastric juice. A current passes down the fundus and greater 
curvature to the pylorus and back along the lesser curvature. 
After an hour of gastric digestion, the tightly closed pylorus 
gradually relaxes, allowing some of the liquid chyme to enter 
the duodenum. Finally, at the end of three or four hours, 
even the more or less solid undigested portion is allowed to 
escape and enter the duodenum. 

Describe the alveolar process and state how it is 
developed. 

The alveolar process is made of an inner plate and an 
outer plate, which are of compact osseous tissue. Between 
these plates there is a cancellous structure which is hollowed 
out into compartments for the different teeth. 

The alveolar process is of mesoblastic origin, being formed 
by the osteoblasts of the periosteum. As the permanent teeth 
form, the process is somewhat rebuilt to accommodate them. 

What is the epiglottis? 

The epiglottis is one of the single cartilages of the larynx. 
It is found at the base of the tongue and on the anterior edge 
of the upper opening of the larynx. 

Describe (a) the arterial system, (b) the capillary 
system. 

The arteries are tubes that carry the blood from the heart 
to the capillaries. The systemic arteries commence in the 
aorta, which divides and subdivides. The cross-section of the 
aorta is much less than the combined cross-section of the arte- 
rioles. The arteries have three coats. The intima consists 
of a layer of endothelial cells on a basement membrane and 
numerous yellow elastic fibers ; the media consists principally 
of involuntary muscular fibers, arranged circularly, which 
are controlled by the local vasomotor ganglia ; the adventitia 
consists principally of areolar tissue containing some elastic 
fibers. The yellow elastic fibers are comparatively more 
abundant in the large arteries ; the muscular more abundant 
in the arterioles. 



392 PHYSIOLOGY. 

The capillaries are small tubes consisting of a single layer 
of lance-shaped endothelial cells. They connect the smallest 
arteries with the smallest veins. They are about one-thirtieth 
of an inch long, and of sufficient caliber to allow a red cor- 
puscle to pass through. 

How is bone nourished? 

Bone is nourished by the blood through the nutrient artery 
circulating in the marrow and Haversian canals. It is also 
nourished by the periosteum. 

State the importance of the blood to the body. 

The blood carries the food and oxygen to the tissues, and 
carries the carbon dioxide and other waste products from 
the tissues to the excretory organs. 

It is also by the circulation of the blood that the tempera- 
ture of the various parts of the body is equalized. 

State the influence of posture on the action of the heart. 

There is an increase of nine to sixteen pulse beats when 
one rises from a reclining to a standing posture; the volume 
and force of the pulse increases at the same time. The effect 
of the sitting posture is intermediate between the two. 

Mention three inorganic substances found in the body. 
State in what part of the body each is found. 

Hydrochloric acid in the gastric juice. 

Sodium chloride in blood. 

Calcium carbonate in bone. 

What is the difference in function between the right and 
left sides of the heart? 

The right side receives venous blood and forces it through 
the pulmonary circulation. 

The left side receives arterial blood and forces it through 
the systemic or greater circulation. 

Describe the physiological action of (a) saliva, (b) gas= 
trie juice, (c) pancreatic juice. 

The ptyalin of saliva converts starch into maltose. 



PHYSIOLOGY. 393 

The rennin of gastric juice changes caseinogen into casein, 
and pepsin in an acid medium converts proteids into pep- 
tones. 

As to pancreatic juice, trypsin in an alkaline solution con- 
verts proteids into peptones or even into lower bodies, leucin, 
ty rosin and arginin. It also changes some of the albuminoids 
into peptone-like bodies. Amylopsin converts starch into 
maltose. Steapsin splits up the fat into fatty acids and 
glycerin. The milk-curdling ferment curdles milk. 

State the function of each of the following muscles: 
(a) temporal, (b) masseter, (c) occipito=frontalis, (d) 
orbicularis palpebrarum, (e) orbicularis oris. 

The temporal and masseter draw the lower jaw upward and 
are muscles of mastication. 

The occipito-frontalis moves the scalp and raises the eye- 
brows. It is a muscle of expression. 

The orbicularis palpebrarum is the sphincter muscle of 
the eyelid ; and is also used as a muscle of expression. 

The orbicularis oris is the sphincter of the mouth. It is a 
muscle of expression; and its contraction will carry the food 
backward into the oral cavity. 

State the normal pulse at each of the following ages: 
One year; ten years; fifty years. 

One year it is 115 to 120. 
Ten years it is 80 to 90. 
Fifty years it is 70 to 75. 

Why is blood light in the arteries and dark in the veins? 

Oxyhemoglobin found in the arteries is a lighter red than 
the deoxidized hemoglobin found in the veins. 

Is the natural condition of saliva alkaline or acid, and 
how is it tested? 

It is alkaline, and is tested with litmus or phenol phthalein. 



394 PHYSIOLOGY. 

What is the normal temperature of the surface of the 
body? 

Very variable. The axillary temperature is about 98 de- 
crees Fahr. 

Define assimilation. 

Assimilation is the conversion into protoplasm of the nutri- 
ent material or food ingested. 

State the use and importance of a (a) perspiration, (b) 
bathing. 

By the evaporation of perspiration the body is kept at a 
fixed temperature. The perspiration carries off waste pro- 
ducts, keeps the skin pliable, and when need exists, relieves 
the kidneys of work. 

Bathing cleanses the external surface, stimulates the func- 
tion of the skin, and increases the general tone of the body. 

State the object of respiration. 

By the act of respiration oxygen is taken into the blood, and 
carbon dioxide, small quantities of nitrogen, water and some 
organic volatile substances are thrown off from the body. 

In some animals the evaporation of water, and thus dissi- 
pation of heat by frequent respirations, is quite marked. 

Describe the movements of the heart. 

The two auricles contracting, force the blood through the 
auriculo-ventricular orifices into their corresponding ven- 
tricles. These in turn contracting, force the blood past 
the semilunar valves into the pulmonary artery and aorta. 
The blood is prevented from regurgitating into the auricles 
during systole by the closure of the auriculo-ventricular 
valves. The ventricles then relax to be refilled with blood 
from the auricles. At the same time the semilunar valves are 
closed by the blood attempting to regurgitate from the arteries. 

During ventricular systole the heart becomes shorter and 
more globular, the base being forced down by the recoil from 



PHYSIOLOGY. 395 

the forcing of the blood into the aorta. The heart rotates a 
little during systole. 

Give the mechanical uses of saliva. 

Saliva assists in deglutition, in mastication, in speaking 
and in taste. 

In what way does absorption of food occur? 

Most of the food is absorbed by the villi in the small in- 
testines. 

Two factors are concerned in absorption, — osmosis and 
vital activity of the columnar epithelium of the villi. 

The soluble salts, glucose, water and peptones are carried 
by the capillaries through the portal vein to the liver and 
from here into the general circulation. 

The fat is carried by the lacteals to the thoracic duct, and 
through it into the left subclavian vein. 

What is the function of the liver? 

The liver secretes bile ; it forms glycogen, urea, uric acid 
and conjugated sulphates. Some of the red corpuscles are 
formed and others destroyed in the liver. The liver also 
destroys some poisons in the circulating blood. 

What is the function of the muscles? 

The muscles move the various parts of the body, and pro- 
duce most of the heat necessary to keep the body at the 
normal temperature. 

Give the symptoms of insufficient oxygen in the blood. 

Dyspnoea, cyanosis, increase of blood pressure, and finally 
exhaustion with decrease of blood pressure, weak, flabby pulse, 
irregular, shallow breathing, convulsions and death. 

Describe the sympathetic nervous system, and state its 
functions. 

The sympathetic nervous system consists of a double chain 
of ganglia extending from the base of the skull to the coccyx 
along the anterior surface of the vertebral column. These 



396 PHYSIOLOGY. 

ganglia are connected by intervening nerves. Besides this 
double chain of ganglia there are three large plexuses of 
fibers and ganglia (cardiac, solar and hypogastric) and numer- 
ous smaller plexuses. Proceeding from the plexuses are 
numerous nonmedullated nerve fibres. 

The sympathetic system controls the movement of the ab- 
dominal viscera, and contains the vasomotor nerves and the 
cardio-accelerator. 

Describe the physiologic action of alcohol. 

Alcohol in small doses is a stimulant to the cerebrum, re- 
spiration, heart, and gastric mucous membrane. In large 
doses it is a depressant to cerebrum, respiration, heart, vaso- 
motor system and gastric mucous membrane. It interferes 
with nutrition and causes a fall in temperatm-e. 

Mention the valves of the heart and give their location. 

The mitral valve is located at the left auriculo-ventricular 
orifice. 

The tricuspid valve is located at the right auriculo-ven- 
tricular orifice. 

The aortic semilunar valve is located between the left ven- 
tricle and aorta. 

The pulmonary semilunar valve is located between the 
right ventricle and pulmonary artery. 

Name five of the principal elements of the body. 

Carbon, hydrogen, oxygen, nitrogen and sulphur. 

Define function. 

Function is the normal activity of an organ or group of 
organs. 

State the normal temperature of an adult; the nor= 
mal pulse of an adult. 

Normal temperature is 98.4 degrees Fahr. 
Normal male adult pulse is 72 per minute. 



PHYSIOLOGY. 397 

State why blood does not coagulate within the blood 
vessels. 

The blood does not coagulate on account of its contact 
with the endothelium of the intima. 

Describe the origin and fate of the red corpuscles. 

In embryonic life the red corpuscles are first formed in the 
Islands of Pander, later by the liver and spleen. After birth 
the red corpuscles are formed in the liver and spleen and 
the red marrow of bones, especially of the ribs. 

They are probably destroyed in the liver and spleen. 

How does the blood coagulate? 

Fibrinogen, a proteid dissolved in the plasma, when acted 
upon by fibrin ferment in the presence of calcium salts is 
changed into fibrin. The clot consists of this insoluble fibrin 
in the meshes of which are the corpuscles. The fibrin ferment 
is formed by the disintegration of the white corpuscles. 

Where and how is the blood changed from arterial to 
venous, from venous to arterial? 

By the process of osmosis, the oxygen passes out through 
the capillary walls into the tissues and carbon dioxide passes 
into the capillaries ; thus it is changed from arterial to venous 
in the capillaries of the tissues. 

The venous blood is forced by the right ventricle into the 
pulmonary capillaries where the blood is separated from the 
atmospheric air by only the capillary wall and the squamous 
epithelium of the air cells. 

There are three factors concerned in the exchange of the 
respiratory gases or changing the venous blood into arterial 
blood. The first is the physiological law of pressure of gases ; 
the second, chemical affinity between hemoglobin and oxygen; 
and third, the selective vital activity of the epithelial cells of 
the air vesicles. 

State the effects of starvation on the human body. 

The bodily weight gradually decreases and the temperature 



398 PHYSIOLOGY. 

becomes subnormal. The fats are used up first, followed 
finally by the proteids, especially of the muscles. The amount, 
of urea excreted is first decreased; but as the increased oxi- 
dation of proteids begins, the urea is increased. Finally 
death ensues from exhaustion. 

The heart and central nervous system lose but little in 
weight. 

Give the physiological properties and the chemical com = 
position of gastric juice. 

Gastric juice is a limpid acid liquid with a specific gravity 
of about 1005. 

It is composed of about 99.5% water and .5% solid. The 
bulk of solids is made up of pepsin, rennin, and hydro- 
chloric acid. Of the hydrochloric acid there arc about two 
parts to the thousand. 

State the effects of battery currents on the normal 
human nerves. 

The faradic current stimulates them. 

A nerve during the passage of a constant current through 
it. is said to be in a state of electrotonus. There is an in- 
crease of excitability at the negative pole or kathode, and 
decrease of excitability at the positive or anode. 

How is the process of nutrition carried on? 

The blood receives the digested and absorbed food and also 
the oxygen from the Inngs. it carries these products to the 
tissues which take out what they need. The blood receives 
the waste and carries it to the various excretory organs. The 
lymphatics also carry some of the waste from the tissues and 
empty it into the venous blood. 

How does lime or other inorganic matter find its way 
into the blood? 

Lime and other inorganic matter enter the body in the 
food and drinking-water, and being absorbed by the villi of 
the small intestines are carried by the portal vein to the liver 
and then into the general circulation. 



PHYSIOLOGY. 399 

Describe the structure and give the functions of the 
veins. 

The veins have three coats : The inner, composed of a layer 
of endothelial cells and elastic fibers; the middle, composed 
principally of involuntary muscular fibers, and the outer, 
composed of areolar tissue with numerous yellow elastic fibers. 

Many of the veins, especially those of the extremities, con- 
tain valves which help the movement of the blood within them. 

The veins carry the blood from the capillaries to the heart. 
They all contain venous blood except the pulmonary veins 
which contain arterial blood. 

State the characteristics of the parotid and submaxillary 
glands. 

The parotid secretion is thin, watery, poor in solids (.3% 
to .5% ) contains no mucin, and has excellent penetrating 
powers. 

The submaxillary secretion on account of containing a 
quantity of mucin, is ropy, contains 2% to 2.5% solids, is of a 
greater specific gravity, and is excellent for aiding deglutition. 
The mixed saliva has a specific gravity of about 1005, is alka- 
line, and contains especially ptyalin, potassium sulphocyanide. 
mucin, sodium chloride and other salts. 

Of what two great groups of substances is the body 
composed? 

t 

Organic and inorganic. 

Mention the organs that compose the respiratory 
apparatus. 

The respiratory apparatus consists of the nose, pharynx, 
Larynx, trachea, bronchi and air vesicles; also of muscles mov- 
ing the thorax, the diaphragm, the nerves (afferent and ef- 
ferent) and the respiratory center in the medulla. 

What are the three kinds of digestion? 

The three kinds of digestion are that of proteids, of carbo- 
hydrates and of fats. 



400 PHYSIOLOGY. 

What are the direct sources of the heat of the body? 

The most of the heat of the body is produced by katabolic 
changes, especially oxidation, taking place in the muscular 
and glandular tissues. 

Describe the parotid gland and give its function. Give 
location of the parotid gland. 

The parotid gland, the largest of the salivary glands, lies be- 
low and in front of the ear. The gland empties its secretion 
by Stenson's duct into the mouth through an opening in the 
mucous membrane, opposite the second upper molar tooth. 
It is a compound racemose gland composed of acini lined 
with polyhedral cells resting on a basement membrane. Un- 
der this is a close network of capillaries. The parotid secretes 
saliva. 

State the functions of dental pulp. 

The dental pulp nourishes the dentine. The odontoblasts 
which it contains form the dentine. The pulp contains nerves 
which give sensation to the tooth and thus protects it in- 
directly. 

How many pairs of cranial nerves are there? What 
nerves supply the teeth? 

There are twelve pairs of cranial nerves. 
The teeth are supplied by the superior and inferior maxil- 
lary divisions of the trifacial nerve. 

* 

On what particular phenomena does the study of physi = 
ology depend? 

Physiology is the study of the phenomena of living 
organisms. 

How does alcohol affect digestion? 

In small doses by its irritant action on the mucous mem- 
brane it causes an increase in secretion of gastric juice. 
Large doses retard digestion, especially that of the stomach. 



PHYSIOLOGY. 401 

In what organs is the blood changed? 

It is changed in all the organs except the heart, but es- 
pecially in the liver, kidneys, lungs, spleen, bone-marrow 
and skin. 

What percent, of the weight of the body is water? 
State the function of water in the body, and how it is 
eliminated from the body. 

i 

About 75% of the body weight is water. 

In all the fluids of the body, water acts as a general sol- 
vent, being necessary to secretion and the carrying of nutri- 
tion to and the waste products from the tissues. By its 
evaporation it dissipates large quantities of animal heat. 

It is eliminated from the body by the kidneys, sweat 
glands, lungs and in feces. 

What set of muscles gives the horizontal motion to the 
inferior maxillary? 

Internal and external pterygoids. 

Define afferent and efferent nerves. 

Afferent nerves carry impulses from the periphery to the 
central nervous system. 

Efferent nerves carry impulses from the central nervous 
system to the periphery. 

Name three kinds of food from which starch is derived, 
and give the percentage of starch in each. 

Potatoes 23.7%. 
Wheat 70%. 
Rice 84.5%. 

What is the function of the gustatory nerve? 

The gustatory nerve is the nerve of taste. 
What is casein, and where is it found? 

Casein is a coagulated proteid found in curdled milk and 
cheese. 

26 



402 PHYSIOLOGY. 

How does the blood circulate through the heart? 

The blood passes from the superior and inferior vena cava 
into the right auricle, which contracting, forces it through 
the tricuspid valve into the right ventricle. The right ven- 
tricle then contracts and forces the blood past the pulmonary 
semilunar valve into the pulmonary artery. This artery 
carries the blood to the lungs, and from these it is carried back 
through the pulmonary veins into the left auricle. Then it 
passes through the mitral valve into the left ventricle, which, 
contracting, forces the blood into the aorta. 

What is the function of the nervous system? 

The function of the nervous system is to carry afferent im- 
pulses from the periphery and as a result of such impression 
to send out efferent impulses, to receive impressions, to pre- 
side over thought, and to control the action of the various 
parts of the body. 

How may coagulation of blood be hastened? 

It may be hastened by increasing the temperature, injury 
to the vessel walls, contact with foreign matter and oxygen, 
agitation and addition of calcium salts. 

State how many of the seventy known elements form 
a practical part in making up the animal tissue, and men- 
tion the four most important of these elements. 

There are sixteen to nineteen elements found in the tissues 
of the body. Of these the most important are carbon, oxygen, 
hydrogen and nitrogen. 

What is food? State why milk is so nearly a perfect 
food. 

Food is that which, taken into the body, nourishes the 
tissues or supplies heat. 

Milk is so nearly a perfect food because it contains all the 
chemical compounds necessary to life, that is, proteids, car- 
bohydrates, fats, salts and water. 



PHYSIOLOGY. 403 

What are proximate principles? 

Proximate principles are substances that enter into the 
composition of the body. 

Name three of the most important inorganic proximate 
principles, and state where they are found in the body. 

Calcium phosphate is found in bone. 
Sodium chloride is found in the blood. 
Water is found all through the body. 

Are inorganic ingredients of food necessary to sustain 
life? Why? 

They are necessary because they are indispensable constitu- 
ents of the structure of the body, — as calcium salts in bone; 
because the alkaline bases are necessary to neutralize the acids 
formed by the proteid metabolism ; because they are necess- 
ary for digestion and absorption, and because water is the 
general solvent of the body. 

Describe the lymphatic system and give its function. 

The lymphatic system consists of lymph capillaries, of nu- 
merous thin-walled vessels lined with endothelium, of lym- 
phatic glands situated on these vessels, of the thoracic duet, of 
the lymphatics of the intestines called lacteals, and the spleen. 

The thoracic duct begins in a dilated extremity called the 
cisterna magna about the level of the second lumbar vertebra, 
and runs up along the vertebral column emptying into the 
left subclavian vein. It receives the lymph from the lower 
extremities, abdomen, left lung, left arm and left face. The 
lymph of the right lung, right arm and right face is emptied 
through a small vessel into the right subclavian vein. 

The lymphatic glands are found along the course of the 
lymphatic vessels, and are composed of lymphoid tissue in the 
center of which are cells rapidly undergoing karyokinesis. 
The lacteals are the lymphatic vessels of the intestines and 
carry the absorbed fats from the villi to the thoracic duct. 

The lymphatic system carries back into the blood circula- 



404 PHYSIOLOGY. 

tion the blood plasma that has osmosed through the capillary- 
walls into the tissues. It also forms leucocytes and carries, 
the absorbed fat from the intestines into the general cir- 
culation. The secretion of some of the ductless glands passes 
through the lymphatics into the blood channels. 

Describe the circulatory apparatus. 

The circulatory apparatus consists of the heart, arteries, 
capillaries and veins. 

The heart is a hollow, muscular organ, lined inside with 
the endocardium and outside with the pericardium. It is 
pyramidal in shape, about 5% inches long, 3Vk inches wide, 
and weighs about ten ounces. It is divided into four cavi- 
ties, two auricles and two ventricles. The ventricles are 
the most important cavities, the left ventricle being three 
times as thick as the right ventricle. 

The arteries are the vessels that carry the blood from 
the heart to the capillaries. They all contain arterial blood 
with the exception of the pulmonary artery. Histologically 
they consist of three coats. The intima or internal coat is 
composed of yellow elastic fibers lined internally with a 
layer of endothelium; the media or middle coat is made up 
mostly of involuntary muscular fibers running transversely 
to the long axis of the artery ; the adventitia or external 
coat is composed of areolar tissue containing numerous yel- 
low elastic fibers. The vaso-motor nerves end in the ganglia 
in the muscular coat. The elastic fibers are found com- 
paratively more numerous in the larger arteries, and the 
muscular fibers in the arterioles. 

The capillaries are the small blood vessels connecting the 
smallest arteries with the smallest, veins, and consist of a 
single layer of lance-shaped endothelial cells. The capil- 
laries on an average are -fo of an inch long and ^^Vtt °f an 
inch in diameter. 

The veins are similar in structure to the arteries but the 
coats are not so thick. Some of the veins, especially those 



PHYSIOLOGY. 405 

of the extremities, have valves which prevent the regurgi- 
tation of blood during muscular contraction. 

What disposition is made of gastric juice after serving 
its purpose in aiding digestion? 

The hydrochloric acid is neutralized 'by the alkaline bile 
and the pepsin is precipitated. 

Define endosmosis, exosmosis. 

Endosmosis is the passage of a liquid through a porous dia- 
phragm from without inward. 

Exosmosis is the passage of a liquid through a porous dia- 
phragm from within outward. 

Give the foramen of exit, principal branches of dis= 
tribution and function of the hypoglossal nerve. 

Anterior condyloid foramen ; branches of distribution are : 
Meningeal, descendens hypoglossi, thyro-hyoid and muscular. 
It is the motor nerve of the tongue. 

Give the functions of that part of the facial nerve which 
is distributed to the oral cavity. 

Influences the sense of taste, mastication and the secretion 
of the submaxillary and parotid glands. 

What is the function of the fifth pair of nerves? 

The fifth nerve is the sensory nerve to the face, oral 
and nasal cavity, and the motor nerve to the muscles of 
mastication. 

What anatomical structures are engaged when the food 
passes from the mouth to the stomach? 

The tongue, soft palate, constrictors of the pharynx, uvula, 
pharynx and esophagus. 

What noticeable change would appear if the seventh 
nerve were excised? 

Complete loss of motion of the muscles of expression of 
the face. 



406 PHYSIOLOGY. 

Mention the difference between parotid and sublingual 
saliva. 

The parotid saliva is thin and watery, while the sublingual 
is thick and viscid, as it contains much mucin. More ptyalin 
is found in parotid saliva than in sublingual saliva. 

What muscles are most active in opening the mouth? 

Digastric, genio-hyoid, mylo-hyoid and platysma myoides. 

Give in the regular order the normal average age at 
which the deciduous teeth are erupted. 

C. 1 5th to 7th month 

L.I 9th " 11th " 

IstM 12th " 14th " 

Cuspids 14th " 18th " 

2ndM 18th " 25th " 

Name the muscles concerned in the act of deglutition. 

Extrinsic and intrinsic muscles of the tongue, tensor palati, 
azygos uvuli, palato-pharyngeus, superior constrictor of 
pharynx, middle and inferior constrictor of pharynx, also the 
muscular coat of the esophagus. 

What are the fluids of the mouth? Give their active 
principle and function? 

Saliva from the salivary glands, and mucus from the mucous 
glands. The active principle of saliva is ptyalin, that of 
mucus is mucin. The function of saliva is to soften and 
moisten the food and to convert starch into maltose. The 
function of the mucus is to keep the mucous membrane of the 
mouth moist. 

Give the period of eruption of the permanent teeth. 

1st M 6th to 7th year. 

C.I. 7th" 9th " 

L. 1 8th " 10th " 

1st B. C. 10th " 11th " 

2nd B. C 11th " 12th " 

Cuspids 12th " 13th " 

2nd M 12th " 13th " 

3rdM 16th " 25th " 



PHYSIOLOGY. 407 

Describe the two systems of nerves in the human body. 

The sympathetic nervous system consists of a double chain 
of ganglia anterior to the vertebrae, several large plexuses 
consisting of large ganglia and numerous nerve fibers and in- 
numerable smaller plexuses supplying the involuntary mus- 
cular tissue. The nerves of the sympathetic system are non- 
medullated. 

The cerebro-spinal nerves are medullated fibers given off 
from the cerebro-spinal axis. They are of two kinds. The 
efferent, supplying principally the voluntary muscular tissue 
and glands and afferent or sensory, carrying impressions from 
the various sense organs to the central nervous system. 

State how the nervous system influences digestion. 

The nervous system influences digestion by means of the 
various secretory nerves and their centres; by the motor and 
inhibitory nerves controlling the movement of the muscular 
tissue of the gastro-intestinal tract and through many af- 
ferent or sensory nerves starting innumerable reflexes. 

State the physiologic relation of the pneumogastric 
nerve to the stomach. » 

The pneumogastric is the sensory, motor in great part, and 
secretory nerve to the stomach. It may also contain some 
inhibitory fibers to the muscular tissue of the stomach. 

Into what classes are proximate principles divided? 
Mention examples of each class. 

The proximate principles of the body are water, salts as 
sodium chloride, proteids as casein, carbohydrates as starch, 
and fats as olein. 

Describe the movements of the ribs during inhalation? 

During inhalation the ribs are raised anteriorly and ro- 
tated outward like the handle of a bucket laterally. They 
are fixed posteriorly to the vertebrae. 



408 PHYSIOLOGY. 

Describe intestinal digestion. 

The partly digested acid chyme passes through the pylorus 
into the duodenum. The bile and pancreatic juice enter 
through a common duct into the duodenum. The glands of 
B runner of the duodenal mucosa and the crypts of Leiber- 
kuhn of the intestines, empty their secretion into the lumen 
of the intestine. The bile neutralizes the acid chyme, pre- 
cipitating the pepsin, thus stopping gastric digestion. It also 
aids in the digestion of the fats. 

The pancreatic juice contains four ferments: the trypsin 
changes the proteids into peptones, the amylopsin changes the 
starch into maltose, the steapsin splits up the fats and a milk- 
curdling ferment changes the caseinogen into casein. The 
invertin of the succus entericus changes the maltose into dex- 
trose. The enterokinase energizes the trypsin, and erepsin 
breaks up the peptones into simpler bodies. We have also in 
the intestines microbic digestion with the formation of various 
gases, as hydrogen sulphide, carbon dioxide, aromatic bodies, 
as indol, phenol, skatol, etc. 

State the function of the facial nerve. 

The facial nerve is the motor nerve to the muscles of ex- 
pression of the face. 

State the function of glycogen. 

The glycogen is used up principally by the muscular tissue 
to supply heat and mechanical energy. 

State where the absorption of proteids takes place. 

The proteids are absorbed principally through the villi 
of the small intestines. 

State how the act of inspiration is accomplished. 

Efferent impulses from the inspiratory centre are sent out to 
the various muscles of inspiration. The diaphragm contracts, 
its central tendon is lowered and the vertical diameter of the 
thorax is increased. The ribs are raised and rotated out- 
ward laterally, thus increasing the anterior, posterior and 



PHYSIOLOGY. 409 

lateral diameters of the thorax. The air then rushes through 
the trachea into the lungs to fill up the partial vacuum thus 
produced. 

Describe the act of mastication. 

The act of mastication consists in the breaking-up of the 
food and mixing it with saliva. This is accomplished by the 
teeth, assisted by the tongue and the muscles attached to the 
jaws and around the mouth. There are three classes of 
teeth ; incisors or cutters, canines or tearers, and molars or 
grinders. 

What proportion of the weight of the body is blood? 
State with regard to blood (a) its specific gravity; (b) its 
reaction; (c) on what its color depends. 

About one-thirteenth of the body weight is blood ; its specific 
gravity is about 1055 ; reaction alkaline. The color depends 
upon its contained hemoglobin. 

Name the successive divisions of the alimentary tract. 

The divisions of the alimentary tract are the mouth, 
pharynx, esophagus, stomach, small intestine (duodenum, 
jejunum and ileum), large intestine, (caecum, ascending, 
transverse and descending colon and sigmoid flexure), rectum 
and anus. 

What organs excrete waste and what does each thus 
remove from the system? 

The lungs remove the carbon dioxide, the skin removes ex- 
cess of water and small quantities of organic material and 
supplements the action of the kidneys. The kidneys remove 
the urea, the phosphates and sulphates from the proteid kata- 
bolism, water, and excess of salts ingested in the food. The 
intestines remove waste thrown off by the liver, refuse of 
digestion and may at times supplement the action of the 
kidnevs. 



410 PHYSIOLOGY. 

State approximately the amount of saliva and of gastric 
juice secreted during 24 hours. 

There is secreted daily about two pints of saliva and ten 
to twelve pints of gastric juice. 

Are the albuminous matters solid or fluid? State where 
albuminous matters are found in the body. 

Albumens are solids but in the body are in solution. 
They are found all over the body. 

Give the composition of perspiration. 

The perspiration contains about one per cent, of solid mat- 
ter, two-thirds of which is inorganic (principally sodium 
chloride and one- third of organic (principally fats and fatty 
acids) with a little urea and epithelial debris. 

Describe the action of the nervous system on the sali= 
vary glands. 

There is a centre in the medulla that controls the secretion 
of saliva. The two efferent nerves from this centre are the 
auriculo-temporal for the parotid and the chorda tympani for 
the submaxillary and sublingual glands. 

The terminals of many afferent nerves when stimulated 
will cause a reflex secretion of saliva. Among these are the 
trifacial terminals in the mucosa of the mouth, vagus ter- 
minals in gastric mucosa, gustatory terminals in the tongue, 
olfactory in the nose, and even the terminals in the uterine 
mucosa. 

State the effect produced by the blood while passing 
through the muscles. 

The blood while passing through the muscles becomes ven- 
ous, giving up the oxygen of the oxyhemoglobin, supplies 
nourishment to the muscle, carries off waste, principally in 
the form of C0 2 . 

State the function of the salivary glands. 

The salivary glands secrete a fluid containing a principle 



PHYSIOLOGY. 411 

called ptyalin which converts starch into sugar. It also aids 
in moistening the bolus of food, thus aiding the digestion. 

Describe metabolism. 

Metabolism is the chemical change going on in organized 
tissue. 

Describe secretions. State how the process of secre= 
tion is carried on. 

Secretions are those products of activity of the epithelium 
of glandular tissue that are of further use to the organism. 
The glands receive their nourishment from the blood. The 
supply of blood is under the control of the vaso-motor system. 
The cells under the stimulus of impulses through the secre- 
tory nerves, or as in the case of the pancreas, from substances 
circulating in the blood (secretin) pick out certain elements 
of the blood and form new substances, which are thrown out 
into the lumen of ducts of the gland. In the ductless glands, 
these products are thrown into the blood-vessels directly or 
indirectly, through the lymphatic system. 

State the character of the food absorbed by the lym- 
phatic circulation and its manner of reaching the blood 
circulation. 

The fats are absorbed through the villi, carried by the lac- 
teals to the receptaculum chyli, thence through the thoracic 
duet into the left subclavian vein. 

Define nerves of special sense. 

The nerves of special sense are the nerves carrying the 
afferent impulses from the various peripheral sense organs to 
the central nervous system. 

Describe reflex action. Give an example of a reflex 
action that is automatically performed. 

A reflex action is an afferent impulse followed by an effer- 
ent impulse and is independent of volition. 

A blow on the solar plexus will cause a reflex slowing or 
stoppage of the heart. 



412 PHYSIOLOGY. 

Describe a ganglion. 

A ganglion is a mass of nerve cells some distance from the 
central cerebro-spinal axis, and has nerve fibers entering and 
leaving it. 

Mention the organs necessary for a sensation. 

For a physiologic sensation there must be a peripheral sense 
organ, the sensory nerve or pathway from it and the cerebral 
center to receive the impression. 

State the average amount of sweat excreted in 24 hours. 
Is this excretion necessary to sustain life? Give reasons. 

The average amount of sweat per day is two pints. 
It is a necessary excretion, as through the sweat most of 
the heat produced in the body is dissipated. 

Give the chemical composition of muscle. 

Muscle contains the proteids, myosinogen, myoalbumen and 
myoglobulen, small quantities of glycogen and inosite, extrac- 
tives as urea, creatin and creatinin, a red coloring matter, 
myokematin and inorganic salts, especially potassium phos- 
phate. It is normally alkaline, but when fatigued becomes 
acid, from the formation of sarcolactic acid. 

Describe the structure and state the functions of the 
skin. 

The skin consists of the cutis vera, formed of dense fibrous 
tissue, the superficial layer being raised into numerous pa- 
pi] las. This is the vascular layer of the skin. The end bulbs 
of the sensory nerves are found here also. Covering the cutis 
vera is the epidermis, formed of numerous layers of epithe- 
lium. There are four strata of the epithelium : the outer, 
horny, or stratum corneum ; the stratum lucidum ; the stra- 
tum granulosum, and the inner or stratum mucosum. 

The function of the skin is to protect the underlying soft 
parts from injury and drying, to protect the sense corpuscles, 
and through the sweat glands and blood-vessels to dissipate 
heat. The hair, an appendage of the skin, protects some of 



PHYSIOLOGY. 413 

the organs from cold, the brain from shock and prevents fric- 
tion, as in the armpits. 

What causes the beat or pulsation of the heart? 

The rhythmic activity of the heart is due to intrinsic prop- 
erty of the heart muscle. According to Loeb it is controlled 
by the proper balancing of the ions of sodium, calcium and 
potassium. 

Has blood plasma an alkaline or an acid reaction? 
Give reasons. 

The blood plasma is alkaline in reaction, due to the dis- 
solved alkaline salts, especially sodium carbonate and phos- 
phate, that it contains. 

Describe by diagram or otherwise a transverse section 
of the spinal cord. 

The spinal cord is a rounded mass of white matter, im- 
bedded in which is a central mass of grey matter, arranged 
like the letter H. The white matter consists of nerve fibers 
and the grey of nerve cells. These are held together with 
neuroglia. The projections backward of grey matter are 
called the posterior horns. These come to the surface of the 
cord postero-laterally. Here the posterior roots or sensory 
nerves enter the cord. 

The projections forward of grey matter are called the an- 
terior horns. Fibers starting here emerge from the antero- 
lateral surface of the cord. In the median line there is the 
anterior median fissure, projecting about one-third of the dis- 
tance into the cord, and the posterior median fissure, project- 
ing about half the distance into the cord. The white matter 
between the posterior horn and the posterior median fissure 
is called the posterior column and is divided into the two 
tracts of Goll (median) and Burdach. Between the anterior 
horn and the anterior median fissure is the anterior column, 
divided into the direct pyramidal (median) tract and the 
anterior ground bundle. The white matter between the two 
horns is called the lateral column and is divided into five 



414 PHYSIOLOGY. 

tracts; the crossed pyramidal tract, trianglar in shape and 
found close to the posterior horn, then along the periphery of 
the cord from behind forward we have the direct cerebellar, 
anterior lateral ascending cerebellar (Gower's) and anterior 
lateral descending cerebellar (Lowenthal's) and deep in the 
lateral column is the deep lateral tract. 

In the grey matter there are two especially well marked 
columns of grey cell, one situated at the base of the posterior 
horn (Clark's column), the other, the inte.rmedio-lateral col- 
umn, between the two horns laterally. 



HYGIENE. 



Mention eight satisfactory disinfectants and give in= 
dications for their use. 

Formaldehyde (1 pound for every 1000 cu. ft. of space), 
sulphur (3 pounds for every 1000 cu. ft. of space) or 
bleaching powder (3 pounds for every 5000 cu. ft. of space) 
to fumigate a room. If sulphur or bleaching powder are 
used, it is necessary to steam the room before beginning to 
fumigate. Chloride of lime to disinfect exerementitious mat- 
ter from typhoid fever, cholera, dysentery, etc. Carbolic acid 
(5% solution) or moist heat (steam and boiling water) to 
disinfect clothing. Bichloride of mercury or permanganate 
of potassium and oxalic acid to disinfect the skin. 

What are the most common sources of infection in 
diphtheria? 

By direct contact with the sputum or shreds of membrane 
from the patient. By inhaling the air in the vicinity of 
the patient. By fomites, clothing, books, drinking- 
cups, etc. 

What conditions are essential to a good water supply? 

Purity at its source, and adequate subsequent protection 
from contamination. 

Describe the hygiene of the mouth and teeth. 

The teeth should be cleansed after each meal and on rising 
in the morning, and foreign matter between the teeth should 
be removed. Acidity of the saliva may be counteracted by 
weak alkaline mouth washes. 

(415) 



416 HYGIENE. 

What methods would you suggest for the hygienic care 
of the skin? 

Simple foods; avoiding constipation; daily exercise in the 
open air; plenty of sleep (at least eight hours daily) ; fre- 
quent warm baths and a cold sponge bath on rising each 
morning. 

Name the kinds of food and the quantity of each for the 
daily use of the normal man. 

4.5 ounces of proteids; 3.5 ounces of fats; 14 ounces 
of carbohydrates; 1 ounce of salts (Moleschott). Or 118 
grains proteids; 56 grains fats; 500 grains carbohydrates 
( Voit) . These quantities represent dry foods. If the diet 
is stated as so-called solid-food (not water-free) the above 
quantities must be doubled. 50 to 80 ounces of water in 
liquid form are also taken into the system. 

Describe in detail the process of disinfection by for- 
maldehyde (formalin). 

Make the room as near air-tight as possible by closing all 
openings and cracks before beginning the process of disinfec- 
tion. All mattresses, pillows, clothing, books, etc., should be 
exposed as fully as possible to the action of the disinfectant. 
Place one pound of formalin for every 1000 cu. ft. of air 
space in a "Novy" generator. Start the rapid volatilizing 
of the formaldehyde and allow the room to remain closed 
for one day. 

What hygienic means should be employed by persons 
prone to " catch cold? " 

A cold sponge bath followed by brisk rubbing on arising in 
the morning; daily muscular exercise in the open air and a 
liberal (but not excessive) diet, largely of carbohydrates. 

What are the sanitary requirements of house plumbing? 

All pipes and connections, traps, etc., should be in view 
or easy of access. Each house must be directly connected by 
pipe with the common sewer. The pipes in the house must 



HYGIENE. 417 

be of iron with leaded joints or screwed couplings. The 
drainage pipes should be laid with a gradient of at least one 
inch fall to every four feet of length ; the main house drain 
must be provided with a trap after it has been carried be- 
yond all house connecting pipes. Pipes from water closet 
fixtures, bath tubs, wash basins and sinks must have traps 
close to each fixture. Soil pipes must extend open for at 
least two feet above the roof and air must be admitted to 
the main trap upon its house-side. 

Describe a simple form of ventilating the sick=room. 

Place a wooden strip about three inches wide and as long 
as the window frame under the lower sash; through the space 
between the top of the lower sash and the bottom of the 
upper, sufficient air will enter the room without producing 
a draught. 

What precaution should be taken in school rooms to 
protect the sight of scholars? 

Pupils should not sit facing the windows (the light should 
come from behind or over left shoulder) ; blackboards should 
not have a glossy surface or be placed between windows. 
The walls of the room should be of a neutral tint. Text 
books should be printed in clear, large type. Faulty pos- 
ture in reading and writing should be corrected by the 
teacher. If toilet accessories are supplied, no child suffering 
from an inflammatory disease of the eyes should be per- 
mitted the use of the general supply. Any imperfection in 
vision of a pupil should be reported to the parents. 

What are the chief sources of contamination to drink= 
ing water? 

The emptying of sewage into the stream from which the 
water supply is obtained; surface water in settled districts 
gaining entrance to the supply; sub-soil water, after passing 
through a filthy soil ; draining from places of burial ; and 
water which has dissolved poisonous minerals. 
27 



418 HYGIENE. 

Describe the different methods of purifying drinking 
water. 

Sedimentation, occurring when collections of water remain 
at rest for a considerable time, removing, in part, at least, 
suspended matter. 

Sand filtration in which the water flows upon and through 
prepared beds of sand, gravel and broken stone, packed in 
separate layers, removes from it not only suspended matter, 
but also dissolved organic matters and bacteria through the 
action of air (oxygen) in the interstices of the filter material, 
and the action of saprophytic bacteria. 

Boiling water will free it of pathogenic bacteria and tem- 
porary hardness, but such water, after boiling, should be 
aerated to fit it for use. 

What do you understand by the " dry earth system " as 
applied to excrementitious matter? 

The container under the privy seat contains the dry earth, 
and after the use of the privy, fresh earth is always to be 
added to the receptacle. From time to time the contents are 
removed and buried or otherwise disposed of. 

Mention some of the results of tobacco smoking in 
growing school boys in respect to the circulation, air pas= 
sages, vision and mental application. 

It depresses the circulation and produces palpitation of 
the heart. It causes low grades of inflammatory processes in 
the upper air passages, catarrhal conjunctivitis, mental 
lethargy with inability to sustained mental application. 

What habits of school children tend to produce myopia? 

Reading of small or imperfect print; faulty positions while 
reading or writing in which the eyes are not far enough re- 
moved from the page. Reading or writing in insufficient 
light, or when fatigued. 



HYGIENE. 419 

What should be the proper temperature for a living 
room in winter? 

72° F. for old or weak persons; 65° F. for the young 
and vigorous. 

What should be the diet of a child over two years of 

age? 

The food should consist principally of milk and bread, with 
rice, tapioca, some vegetables of easily digestible character 
and sparingly of fruit, preferably cooked; but little meat 
should be allowed and this preferably mutton. 

What is the most sanitary way of disposing of city 
garbage? 

Burn it, so that all noxious vapors are also consumed. 

Mention six desirable factors in the location of a resort 
for consumptives. 

Equable climate, high altitude, dry atmosphere, pure air, 
abundant sunshine and pine forests are climatic factors for 
consumptives. 

State the accepted belief in respect to the limitation of 
protection from vaccination. 

Five years, when revaccination should be attempted. Dur- 
ing a small-pox epidemic it is advisable to revaccinate all 
individuals who have not been vaccinated Avithin two years. 

Mention some of the adulterations in preparations of 
ground coffee for sale in the shops. 

Chicory, peas, roasted cereals and legumes, date stones, 
acorns, sawdust, etc. 

What class of foods should predominate for persons 
over sixty years of age? 

Use eight-tenths the quantity of proteids that the vigor- 
ous adult requires; seven-tenths the quantity of carbo- 
hydrates; and one and two-tenth times the quantity of fats. 



420 HYGIENE. 

Which in your judgment is to be preferred in vaccin- 
ation, animal or humanized lymph, and why? 

Animal lymph, because in its preparation greater care may 
be taken to secure its freedom from deleterious additions. 

Name some of the nuisances dangerous to health. 

Gases and dust of a poisonous or irritating nature arising 
from many manufacturing industries. Collection of stag- 
nant water, garbage and animal excreta exposed to the air; 
leaking drains or sewers saturating the soil, or allowing the 
escape of gases. Industries giving rise to great noise or 
vibration in thickly settled communities. 

What is the best means for preventing the access of 
sewer gas in dwellings? 

Place a trap or water seal between the house drain and the 
sewer, and provide an air inlet pipe to open into the drain 
pipe between this trap and the house. A ventilation pipe 
should extend from the house drain to a point above the roof. 

Name the diseases the predisposition to which is greatly 
increased by the use of alcohol. 

Disease of the heart and vascular system, the kidneys, 
brain and liver and of the respiratory system, particularly 
pneumonia and asthma. 

Name four diseases that are communicable to man 
through cows' milk. 

Typhoid fever, scarlet fever, cholera and tuberculosis. 

To what is indigestion from excessive tea drinking 
attributable? State a formula for the preparation of 
good tea. 

The indigestion is caused chiefly by tannin ; also by 
theobromin. 

Pour one pint of boiling water over a dram of the dried 
tea leaves and allow it to stand, without applying further 
heat, for five minutes. 



HYGIENE. 421 

Mention some of the advantages of carefully prepared 
artificial ice as compared with natural ice. 

It may be made from distilled water so as to be ab- 
solutely pure. It may be obtained in any size or shape and 
its texture is more uniform. 

What precautions as to food and drink should be ob= 
served by those forced to work under the direct rays of 
the sun in summer weather? 

A small quantity of readily digestible food should be 
eaten before going to work. Liquids of a nonalcoholic charac- 
ter may be used liberally, provided perspiratory function is 
actively performed. Very cold drinks should be avoided. 
Meat should be largely excluded from the diet. 

What are the best methods of ventilating dwellings, and 
what sanitary principles are involved? 

The perflating action of wind should be utilized at least 
once each day for all rooms. One of the best methods em- 
ployed is the open fireplace, provided such fireplaces be sup- 
plied with properly constructed chimney exits. Instead of 
this plan, fresh air may be admitted through ventilators, or 
between the upper and lower window sashes. The object 
sought in these devices is to admit cold air above the heads 
of the occupants of the room so that the fresh air may pass 
through the upper portions of the room and become heated 
before reaching the occupants. The usual outlet for foul air 
is the chimney flue, but when this is not present, it may be 
replaced by an opening for the exit of air placed near the 
floor of each room. When the incoming air is not heated 
the outlet should be at the top of the room. During cold 
weather the rate or interchange of air should not be greater 
than sufficient to change the air of the room three times an 
hour. The air which enters should not have a greater velo- 
city than five feet per second or about 3.4 miles per hour. 



422 HYGIENE. 

What hygienic precautions are necessary to insure 
healthy sleep? 

A well ventilated room, temperature about 60° P. Room 
and bed should be perfectly clean and the covers of the bed 
not too heavy. The head of the person should be slightly ele- 
vated. Noise and light should be excluded from sleeping 
apartments. 

What deleterious gases accumulate in improperly venti- 
lated sleeping rooms? 

Carbon dioxid ; carbon monoxid, if rooms be heated ; hydro- 
gen sulphid ; ammonium sulphid, and many gases of an or- 
ganic ammoniacal character. 

Does change in climate require any change in food; if 
so, what? 

Yes. In cold climates a greater quantity of food should 
be consumed than in hot climates. Food that is productive 
of the greatest number of heat units, as fats and meals, 
should be partaken of in cold climates. In hot climates the 
diet should consist almost entirely of well-cooked vegetables 
and ripe fruits; with the avoidance of alcoholic beverages. 

What are some of the dangers of the cold bath? 

In those of feeble circulation and at the two extremes of 
life, chilling of the surface of the body leading to internal 
congestion that may result in acute inflammation, particu- 
larly of the lungs, kidneys, stomach and bowels. Shock seri- 
ously affecting the heart; and the production of a persistently 
lowered temperature of the body. 

What effect has ground air and water on the health? 

Ground air is always impure, being contaminated with 
bacteria, carbonic dioxid and often with more poisonous 
gases. It occasions various degrees of ill-health, varying from 
slight general malaise to one of the acute infectious diseases 
or tuberculosis. Ground water from near the surface of 
polluted soils may be noxious. It causes dampness of the 



HYGIENE. 423 

walls of houses, inviting rheumatic diseases and catarrhal 
inflammations. 

Define the word " nuisance " in a broad hygienic sense. 

"Something which either actually injures, or is likely to 
injure health, and admits of a remedy either by the individual 
whose act or omission causes the nuisance, or by the local 
authority" (Winter-Blyth). 

What injurious influences, if any, do cemeteries exert 
on the health of persons living in their vicinity? 

To most persons the mental effect is depressing. Water 
passing through the soil of cemeteries may contaminate the 
water supply of the neighborhood, with organic material and 
micro-organisms. The constant turning of soil of cemeteries 
may set free imprisoned gases from organic decomposition, 
and lead to contamination of the surrounding air. 

What gases and combination of gases are most efficient 
as disinfectants? 

Formaldehyde, sulphur dioxid, chlorin. ozone. 
What care should be employed in exhumations? 

The exhumation of those dead of contagious or infectious 
diseases should not be allowed. When possible, the exhum- 
ation should be deferred until cold weather. The presence 
of all persons except those absolutely needed should be for- 
bidden. As the workmen approach the coffin the earth should 
have poured upon it a strong watery solution of creolin. The 
coffins containing the remains should not be opened, but be 
placed at once in a zinc-lined box and hermetically sealed. 

What are the hygienic requirements and the physio= 
logical effects of bathing? 

The bath should be taken to obtain personal cleanliness, as 
well as for its stimulation of the peripheral circulation. 
Bathing should be postponed until at least two hours after 
a meal, and should consume only twenty minutes. Never 
bathe when very hungry, or when the body is overheated. 



424 HYGIENE. 

Unless experience has shown that good effects accrue from 
a cold bath, secure a temperature of about 65 to 75 degrees 
Fahr. of the water. The bath should be followed by a 
thorough drying and brisk rubbing. Effects following a 
bath are removal of dirt and of dead epithelium from the 
person, stimulation of the functional activity of the skin; 
a general improvement in the circulation and increased func- 
tional activity of the organs of elimination. 

How much fresh air is required for normal respiration 
during 24 hours? 

3000 cubic feet per hour, or 72,000 cubic feet of air in 
24 hours. 

How may a privy in city or country be kept while in 
use from becoming a nuisance? 

Have the privy emptied at frequent intervals. At inter- 
vals of five to seven days, pour into the privy vault milk of 
lime (about 20 grains of lime for each gallon of sewage), or 
strong solution of iron sulphate ; or at frequent intervals add 
clean, dry earth to the privy contents, and provide a ventilat- 
ing pipe extending high in the air and down into the privy 
vault. 

What explanation can be furnished for the greater pre= 
valence of diphtheria and smalNpox in cold than in warm 
weather? 

During cold weather the houses are less perfectly venti- 
lated than in warm weather. Rooms are frequently over- 
heated, less attention is paid to personal cleanliness and 
there are more sudden changes in temperature. Such con- 
ditions lower the vitality of the body and predispose to 
disease. 

What are the principal adulterations of milk? 

Addition of water and abstraction of cream ; addition of 
coloring water (annatto, caramel) ; preservatives (borax and 
boracic acid, salicylic acid, formaldehyde, chromates) ; gela- 
tine as a thickening for cream. 



HYGIENE. 425 

What changes in food are affected by cooking? 

Parasites and germs are destroyed ; the food is made more 
tender to facilitate mastication. The tough fibrous envelope 
of starch cells is softened, albumen is coagulated, the food 
is rendered more palatable, and the action of the different 
digestive fluids is aided. 

State the advantages of cremation over earth burial. 

Complete destruction of specific disease germs. If crema- 
tion be well performed no obnoxious gases are given to the 
air, no gases of putrefaction contaminate the air, and there 
is no danger of contaminating the water supply through 
drainage from cemeteries. 

What are the respective merits of cotton, wool and silk 
when used as underwear? 

In a variable climate wool is preferable because from a 
larger amount of air enclosed in its texture it acts as a 
good non-conductor of heat, retaining the body heat. As 
wool is hygroscopic it readily absorbs moisture from which it 
parts slowly, so preventing surface chill of the individual by 
too rapid evaporation. Next in order to retain the heat of 
the body we rank silk and least valuable for the retention 
of body heat is cotton. If it be our purpose to supply a 
cool garment we would of course reverse this order of 
arrangement. 

What conditions of ill health make residence in high 
altitudes dangerous? Why? 

Chronic Bright 's Disease, disease of the heart, emphysema; 
and old age. High altitudes occasion increased respiratory 
effort from the rarified condition of the atmosphere, causing 
increased heart action, and a lessened perspiratory function. 

State the physical condition that makes the practice of 
taking hot baths inadvisable. 

Acute inflammatory diseases, tuberculosis, organic diseases 



426 HYGIENE. 

of the heart and brain, aneurism, cancer, and all diseases in 
which stimulation of the circulation is to be avoided. 

State some of the sequelae of (a) over=strain, (b) over= 
exertion, (c) over=training. 

(a) Parting of continuity of osseous, ligamentous, muscu- 
lar or bloodvessel structure leading to fractures, dislocations, 
rupture of muscles, hernia, rupture of heart muscles, disease 
of valves of heart and apoplexy. 

(b) May produce same conditions as over strain and in addi- 
tion cause general muscular relaxation, dyspnea, syncope, etc. 

(c) Loss of appetite and of muscular power, successive 
crops of boils appear, individual loses mental power, as of con- 
centration of thought, and digestive disturbances occur. 

What constitutes hard water and soft water? 

"Hardness is the capacity a water has for decomposing 
soap, and depends on the amount of salts of magnesia and 
calcium in solution." (Harrington.) 

Soft water contains little or no dissolved salts and rapidly 
forms a lather with soap. 

Mention the dangers of excessive shade about dwellings. 

Excessive shade interferes with the free movement of air, 
prevents penetration of the sun's rays, promotes dampness 
which is given "off to the air by evaporation. It exerts a 
depressing mental action, promotes the growth of fungi and 
bacteria, and prevents the aspirating action of heat from the 
sun upon air and moisture in the soils. 

What is milk sterilization? How is it performed? 

Destruction of micro-organisms in the milk by heat. By 
continuous heating of the milk, under pressure, for two hours 
at 248° F. 

What infectious diseases may be due to impure drink- 
ing water? 

Typhoid fever, malarial fevers, cholera, relapsing fever, 
dysentery, parasitic diseases. 



HYGIENE. 427 

Describe the physiological action of alcohol. 

Small or therapeutic doses increase the pulse rate and the 
arterial pressure by directly stimulating the heart. Over- 
doses directly depress and paralyze the heart muscle. Large 
doses produce decided lowering of body temperature. It is 
probable that the use of alcohol diminishes the elimination 
of CO,. Alcohol causes a. great lessening in the excretion of 
the products of tissue waste. It is probable that alcohol in 
not too large quantity is entirely destroyed in the body. In 
small doses alcohol acts as a cerebral stimulant, while larger 
doses greatly depress and abolish nervous activity, and check 
digestion. The habitual use of alcohol is accompanied by a 
disposition towards fatty degeneration, particularly of heart 
muscle, liver and kidneys, and an enlarged and dilated con- 
dition of the smaller bloodvessels and a degeneration of all 
nervous structures. 

Does alcohol possess a food action? On what do you 
base your answer? 

Yes. "In the sense that it is destroyed in the system and 
yields force utilized by the organism, and is, when in suffi- 
cient quantity, a retarder of tissue change, checking the ex- 
cretion of nitrogen" (H. C. Wood). We see this in its 
administration in typhoid and other long-continued fevers. 
Yet it is not a true food, since it also exerts toxic effects, 
which foods do not. 

The excavations of streets in cities is frequently fol= 
lowed by the outbreak of disease, such as diphtheria, 
typhoid fever. What is the cause? 

Pathogenic bacteria lie dormant in the soil of cities, and 
when such soil is exposed to the air, it becomes dried, and its 
contained bacteria taking on an active existence are liberated 
and carried by the air to susceptible individuals. 

How long does a diphtheritic patient remain infective? 



428 HYGIENE. 

How may it be proved that this infective period has 
ceased? 

About three weeks after local symptoms cease. Make fre- 
quent cultures of material from the affected site, and when 
such fail to show the specific germ, the patient will no longer 
be a source of infection. 

How may milk be the means of transmitting the germs 
of typhoid fever? 

Through water containing Eberth's bacillus, gaining access 
to the milk, as through diluting the milk, washing milk 
receptacles in polluted water. 

Mention the effects of working in phosphorus, as in the 
manufacture of phosphorus matches. How can the dan= 
gers be limited or prevented? 

Inhaling phosphorus fumes produces a form of necrosis of 
the jaw, particularly in such as have imperfect teeth. To 
avoid its development persons of sound teeth and free from 
abrasion of the interior of the mouth should be employed. 
The work room should be large and well ventilated, with 
special air shaft to force the fumes away from the faces of 
workers; the employes should have short working hours, and 
frequently use a mouth wash and gargle of lime water or 
carbonate of sodium. Turpentine and charcoal should be 
exposed in the room. 

What fruits are preferable in cases of habitual con- 
stipation. 

Apples, prunes, figs, grapes and melons. 

Describe the effect of a hot and moist climate on the 
human system and state the class of diseases this at- 
mosphere is likely to induce. 

In hot and moist climates the inhabitants, as a rule, are 
of small stature and deficient in muscular development; of 
languid disposition and nervous temperament. The diseases 
most prevalent are those affecting the liver and gastro-intes- 



HYGIENE. 429 

tinal tract; also various forms of malarial disease, and yellow 
fever. 

What occupations are a menace to public health? Why? 

Those occupations that emit irritating, poisonous or noxi- 
ous fumes and gases from the vitiation of the atmosphere, 
as in fertilizing plants, chemical manufactories, bone-boiling 
establishments ; also such occupations as give rise to much 
dust, especially if this be of sharp, hard character, as from 
cement making, in which the respiratory tract is subjected 
to irritation. 

Mention some of the objections to storage cisterns 
underground. What are the objections to rain water as 
a drink? 

They often receive dust and dirt; sewer gas may gain en- 
trance to the water when the "standing waste" or overflow 
pipe of such cistern is connected with the drain or soil pipe 
of a house. Storage cisterns cannot be properly ventilated, 
and are often difficult to clean. 

If the first part of the rain be collected, such water will 
contain dust, pollen, gases and other matters washed from 
the air. 

Give an opinion as to the sanitary effect of the different 
methods of heating houses. 

The most desirable method is by Hot Water Heating by 
means of a complete plant with circulation of the hot water 
through radiators. Next in value to hot water heating is 
steam heating by radiators or by indirect radiation. The use 
of open fireplaces in the principal rooms is of great value in 
securing ventilation, but yields an unequal and insufficient 
supply of heat. Heating a house by hot air from basement 
heaters is efficient and gives good results, if the air supplied 
to the heater for distribution is pure and the house is not 
too large. 



430 HYGIENE. 

Name eight principal carbohydrates used as food. 

Starch, glucose, saccharose, lactose, dextrin, cellulose, mal- 
tose and dextrose. 

Name the class of foods which should be given to chil= 
dren between the first and second years of age. 

We should supply foods in about the proportion of 2 parts 
proteid, 3 parts fat, 6 parts carbohydrates, the proteid food 
being preferably milk. 

What are some of the dangers involved in the domestic 
use of ice? 

Ice may contain pathogenic bacteria, and may, when re- 
moved from a sickroom, transmit infectious disease to other 
members of the household. 

Define the term " quarantine," mention the principal 
quarantinable diseases, and give the rules for determine 
ing the length of time each should be quarantined. 

"The adoption of restrictive measures to prevent the intro- 
duction of diseases from one country or locality into an- 
other." (Wyman). 

Quarantinable diseases include cholera, small-pox, yellow 
fever, plague, scarlet fever, diphtheria, typhus fever, relaps- 
ing fever, cerebro-spinal meningitis, leprosy. 

In eruptive fevers isolation of the patient (quarantine) is 
continued for two weeks after the eruption has disappeared, 
except in the case of small-pox where quarantine lasts 30 days. 

The quarantine in diphtheritic cases does not cease until 
cultures made from the throat of the patient fail to show 
the bacillus of diphtheria. 

State the best means of disinfecting sputum. 

Sputum may be burned or received into vessels containing 
strong antiseptic solutions. 

What is understood by the germ theory of disease? 



HYGIENE. 431 

Mention all diseases whose causes are known to be specific 
microorganisms. 

The genii theory of disease contends that the exciting cause 
of each infectious or contagious disease is some specific 
organism, and that these diseases are communicated only by 
the transference to and development of the particular para- 
site or germ within or upon the tissues of the infected 
individual. 

Diseases due to specific micro-organisms are tuberculosis, 
diphtheria, cholera, typhoid fever, dysentery, pneumonia, 
glanders, leprosy, anthrax, erysipelas, gonorrhea, relapsing 
fever, malaria, plague and tetanus. 

Can it be proved that the diminished death rate from 
diphtheria so generally announced is due to the use of 
diphtheria antitoxin? Give reasons. 

Yes. By comparing the death rate in hospitals treating 
the same class of patients, in the same community, during 
the same time, the one hospital using diphtheritic antitoxin, 
the other depending upon other methods of combating the 
disease. Where the antitoxin is used, the death rate is much 
lower. 

Give the comparative nutritive value of sterilized or 
unsterilized cows' milk. 

The nutritive value of sterilized milk is less than of milk 
unsterilized. 

What evil consequences frequently result from the ex= 
cessive use of tobacco? 

Catarrhal inflammation of pharynx, tonsils and mouth. 
Nervous disorders of heart as palpitation, and insomnia also 
result. Derangements of stomach with loss of appetite, and 
impairment of vision together with paralysis of optic nerve, 
nervous tremors, and muscular twitchings may result. 

Mention five preventable diseases. 

Tuberculosis, typhoid fever, cholera, yellow fever and 
malaria. 



432 HYGIENE. 

What is the best sanitary plan for the disposal of 
sewage? 

Collect the sewage in large tanks and to it add lime, alum 
or iron sulphate. Compress the solid materials after their 
subsidence or precipitation and cremate them. Allow the 
liquid sewage to flow upon specially prepared filter beds which 
are subdrained : the water flowing from these sub-soil pipes 
may then pass into a stream without great danger of adding 
poisonous material or pathogenic bacteria. 

What diseases are propagated by drinking water? 
How can their spread be prevented? 

Infectious diseases, particularly cholera and typhoid fever; 
diseases due to gastric and intestinal irritation, as forms of 
dyspepsia, diarrhoea, dysentery ; diseases due to animal para- 
sites; diseases due to metallic poisons. 

Prohibit the use of water containing any dissolved metal. 
Distil the water, or boil it for at least one half hour, thus 
purifying it. 

State the results to animal life of the combustion of 
fuel in a room without chimney connection or other 
ventilation. 

Carbon monoxid poisoning, suffocation due to excessive 
quantity of carbon dioxide and diminished amount of 
oxygen ; a systemic poisoning due to breathing products 
which are the result of partial burning of excretions thrown 
off in exhalations. 

State the original source of all fresh water. 

The original source of fresh water is rain. 

State the impurities which rain water may contain. 
Describe the great value of rain water for domestic pur> 
poses and state the great objection to its general use. 

Rain water may contain microscopic growths, bacteria, 
ammonia, nitric and nitrous acid and other impurities from 
the collecting surface. 



HYGIENE. 433 

On standing in the cistern many bacteria and other mi- 
croscopic growths may rapidly render it unfit for use. 

Rain water on account of its softness is of great value for 
cooking and washing purposes. The great objection to use 
generally is the limited and uncertain supply. 

In what part of an occupied room is the most impure 
air found? Give reasons. 

The lower part of an occupied room contains the most im- 
purities. The carbon dioxide is heavy and tends to accumu- 
late in the lower part of the room. The dust and other solid 
impurities are more abundant near the floor. 

State the composition of atmospheric air. Is the mix- 
ture a chemical or mechanical one? 

Atmospheric air is made up of 20.96% of oxygen, .04% of 
carbon dioxide and 79% of nitrogen and other inert gases as 
argon and crypton. 

The mixture is a mechanical one. 

State the nervous disorders most common among school 
children. Mention some of the causes of these disorders. 

Among the many nervous disorders of school children are 
chorea, habit spasm, refractive errors of vision, deafness from 
catarrhal condition of nose, degeneracy, mental dullness and 
later in school life, neurasthenia. 

Among the causes of these are overcrowding, faulty light, 
lack of proper ventilation, improper desks, lack of personal 
hygiene, heredity, cramming and lack of proper food and 
exercise. 

State the average proportion of carbon dioxide in iooo 
parts of atmosphere. What should be the maximum limit 
of carbon dioxide in school rooms? 

Four parts of carbon dioxide to teD thousand of air is the 
normal. 

The maximum limit of carbon dioxide in a school room 
should be .05%. 
28 



434 HYGIENE. 

State the hygienic precautions that should be taken to 
prevent the spread of typhoid germs. 

The drinking water should be boiled, and the milk also if 
it is suspected of possibly being infected. 

The feces and all secretions, like urine and nasal mucus 
should either be destroyed by fire or properly disinfected with 
a strong solution of bichloride of mercury, chlorinated lime, 
formalin or carbolic acid. 

The clothing of the patient and the bed linen should be 
placed in strong bichloride solution, or preferably boiled 
for a half hour. 

The glasses and other dishes used by the patient should be 
boiled. 

What instruction as to hygiene and sanitation should 
be given in a case of diphtheria? 

The case should be isolated, the house quarantined, and 
possibly those who have been exposed (especially children) 
had better be given a small dose of antidiphtheritic serum. 

The room should be well ventilated and as much sunshine 
as possible allowed to enter. 

The discharge from the mouth and nose should be de- 
stroyed by fire; the dishes should be boiled. 

The clothing and bed linen should be boiled or destroyed 
by fire. 

After the case has terminated the room should be thor- 
oughly disinfected with formalin or sulphurous acid, and the 
woodwork washed with 1 to 1000 bichloride of mercury 
solution. 

Name some of the impurities found in rain water that 
is stored in cisterns. 

Unicellular organisms of many kinds, decaying vegetation, 
nitrites, ammonia, nitric acid, and mechanical impurities. 

What are the general effects of breathing impure air? 

You get the symptoms of intoxication from the impurities 



HYGIENE. 435 

of the air, such as headache, general malaise, loss of appetite, 
interference with mental activity, also interference with mus- 
cular activity, weak, low-tension pulse. 

State the composition of pure air; of expired air. 

Pure air consists of 20.9 parts of oxygen, .04 parts carbon 
dioxide and 79. -4- nitrogen and other inert gases. Expired 
air consists of 15.9 parts of oxygen, 4.5 parts of carbon dioxide 
and 79. + nitrogen. 

If a chemical analysis of water revealed the presence 
of nitrites and nitrates, would this condemn it for drink- 
ing purposes, if so, why? 

Yes, particularly if nitrites be present. Organic matter, 
particularly sewage, is converted first into nitrites and these 
into nitrates through the action of bacteria in the soil. These 
salts would, therefore, indicate a former pollution of the 
water with probably some of that polluted material still in 
the water. 

If nitrates only are present and it can be shown that the 
organic matter is of a vegetable origin only, the water need 
not be condemned. 

On what generally accepted theory are toxins used for 
the prevention and cure of disease? 

That their presence in the system renders the blood no 
longer able to support the lives of bacteria that occasion 
such toxins. 

Under what condition is tyrotoxicon found in milk, 
cheese and other articles? 

Where milk, cheese, ice-cream, etc., undergo decomposition 
in the presence of other organic matter, as rotting wood, 
mould, etc. 

Describe the agency of the ptomaines in inducing dis= 
eases and the disorders produced by them. 

Ptomaines are alkaloidal bodies resulting from decomposi- 



436 HYGIENE. 

tion of nitrogenous substances. When absorbed into the 
blood they may give rise to fever, headache, torpor, fetid 
breath. They act like chemical poisons very soon after their 
introduction into the system. Many of them occasion dis- 
tinctive trains of symptoms. 

Mention an infectious disease which is often caused by 
drinking water and show how the germs of this disease 
are communicated to the water. 

Typhoid fever is frequently caused by drinking water. The 
excretions of the body are thrown on the ground or into im- 
properly made cesspools, and then drain into the drinking 
wells, or the excretions are thrown into a creek or river and 
carried down to a city that uses this river as a supply for 
drinking water. 

State the number of cubic feet of oxygen absorbed in 
24 hours. 

There are 27 cubic inches of pure oxygen absorbed in one 
minute or 22y 2 cubic feet daily. 

Mention six kinds of food from which starch is derived. 

Starch is derived from potatoes, corn, rice, wheat, oats 
and sago. 

What is the lowest temperature of steam heat at which 
pus cocci are destroyed? 

At 240 deg. Fahr. such organisms are killed in a few 
minutes, while at 212 deg. Fahr. it requires an exposure to 
steam of from thirty to forty minutes. 

What is the temperature of tepid water, of hot water, 
of boiling water? 

Tepid water 75 to 85 deg. Fahr. 
Hot water 100 to 110 deg. Fahr. 
Boiling water 212 deg. Fahr. 

Differentiate between endemic and epidemic diseases. 

An endemic disease is one constantly present in a commun- 



HYGIENE. 437 

ity. An epidemic disease is one which spreads rapidly, at- 
tacking many people at the same time. 

What is meant by natural and acquired immunity from 
disease? Give an example of each. 

By natural immunity we mean "'that inherited trait from 
immune ancestors which enables an organism to resist the 
attacks of bacteria and their toxic secretions." Thus, as a 
rule the negro race does not contract yellow fever. By ac- 
quired immunity we understand that through a previous at- 
tack of an infectious disease, or by inoculation with an at- 
tenuated virus of that disease, the blood of the person under- 
goes such changes as to present a non-fertile soil to the or- 
ganism to whose presence the disease is due. Example, vac- 
cination in preventing small-pox. 

Describe vitiation of the air from lack of ventilation. 

The vitiation of the air from lack of proper ventilation is 
caused by the using-up of the oxygen, the accumulation of 
carbon dioxide and other waste products thrown off by the 
respiratory tract and skill. 

What should be the lowest specific gravity of fresh 
milk? 

The lowest specific gravity of fresh wilk should be 1029. 

In ioo parts of cow's milk, mention the per cent, of 
proteids, fats, sugar, salts and water. 

There is in cow's milk about 4+ each of proteids, fats and 
sugar, about .7% of salts and the rest is water. 

State the advantages of a mixed diet. 

In a mixed diet one is more apt to get the right amounts 
of proteid, fats, carbohydrates and salts, the food is not too 
concentrated, nor does it contain too much waste, like cel- 
lulose. Proteids are absolutely necessary in the food. The 
vegetable foods are poor in proteid and the proteid is not as 
readily digested. Change of diet increases the appetite and 



438 HYGIENE. 

this physical influence is the most powerful in causing a 
proper flow of the various digestive secretions. 

State a method of disinfecting a room that has been 
occupied by a diphtheritic patient. 

The bedding, unless it can be subjected to superheated 
steam, had better be burned. The room should be thor- 
oughly filled with abundance of formalin spray and kept 
closed for 24 hours. The room then should be thoroughly 
aired and exposed to the sunlight. The room should be re- 
papered and the woodwork and the floor washed with a 
1-1000 solution of mercuric chloride. 

How may the germs of infectious diseases be introduced 
into milk? 

The germs of infectious diseases may be introduced into 
milk by washing the milk cans with infected water, by water- 
ing the milk with infected water, from the hands of those 
handling the milk, from infected cows (as tuberculosis) and 
by contact of infected air with the milk. 

State the objection to the use of wells within the 
city limits. 

The objection to these wells is, they are very likely to drain 
the nearby cesspools and the surface sewage, unless they 
are thoroughly made wells that pass through at least one 
layer of solid rock. 

Does regular physical exercise affect the condition of 
the mouth? If so, how? 

It affects the condition of the mouth by increasing the tone 
of the whole body, stimulating especially the circulation 
and secretion. 

What is the best method of disinfecting instruments? 

The best method is moist heat. 

State what hygienic measures a dentist should employ 
after operating at a chair. 

He should clean the nose, throat and mouth with an anti- 



HYGIENE, 439 

septic solution ; lie should scrub the hands and place them 
in antiseptic solution for a few minutes. 

The instruments should be sterilized and the room aired if 
possible. 

What hygienic care should be given to an operating 
room? 

An operating room should be well ventilated without 
draughts, well lighted, scrupulously clean, well heated and 
should be rendered as nearly aseptic as possible after a 
septic operation. 



ANATOMY. 



What is connective tissue? (b) Where is it found in 
the human body? 

The term connective tissue includes a number of tissues 
which, serve the purpose of "connecting" and supporting dif- 
ferent tissues of the body. It is generally applied to tissue 
which fills in the interstices between organs, etc., and binds 
and supports them together. Most typically, it is found 
between muscles and surrounding blood-vessels. 

Give a general description of the nervous system. 

It consists of central and peripheral portions, the former 
made up largely of cells, and the latter of fibers. The brain 
and cord are contained in the cranial cavity and spinal canal. 
The brain, or encephalon, consists of cerebrum, cerebellum, 
pons and medulla; 12 pairs of nerves (cranial) pass out from 
these divisions through foramina in the cranial floor. The 
spinal cord has 31 pairs of spinal nerves attached to it. The 
eerebro-spinal axis is protected by 3 meninges, the dura, the 
arachnoid and the pia. 

The peripheral nervous system consists of nerves of special 
sense, of motion and of sensation; many of them are mixed 
nerves, as to function. In the cervical and lumbar regions, 
the spinal nerves unite to form the cervical, lumbar and sacral 
plexuses. 

The so-called sympathetic system, most intimately con- 
nected with the eerebro-spinal system, consists of collections 
of nerve cells known as ganglia, and of nerve fibers proceed- 
ing from these ganglia and uniting to form many plexuses, 

(441) 



442 ANATOMY. 

the largest of which axe the three prevertebral, or the cardiac, 
solar and hypogastric plexuses. From these plexuses fibers 
proceed to supply viscera and blood-vessels. 

Describe the sphenoid bone. 

By reason of its location at the base of the skull, it arti- 
culates with all of the bones of the cranium and with five 
of the face. It forms the greater part of the middle cerebral 
fossae ; it consists of a body, two greater and two lesser wings, 
and a pair of pterygoid processes. The body is hollow and 
contains the sphenoidal cells, or sinuses; between the greater 
and lesser wings, on each side, is the sphenoidal fissure, which 
transmits the ophthalmic division of the 5th cranial nerve, 
the 3d, 4th and 6th cranials, and ophthalmic vein. On the 
upper surface of the body is the sella turcica, which re- 
ceives the pituitary body; on either side of the body is the 
groove for the cavernous sinus ; in the greater wing are the 
foramina rotundum. ovale and spinosum, for the maxillary 
division of the 5th. the mandibular division of the 5th, 
and the middle meningeal artery, respectively. The greater 
wing forms, anteriorly, part of the wall of the orbit, and 
externally, part of the temporal fossa ; the pterygoid process 
helps to form the pterygoid fossa, externally, and the outer 
wall of the posterior naris, internally. 

State the location, size and structure of the cerebellum. 

Is located in the cerebellar fossae of the occipital bone, 
beneath the tentorium cerebelli; it measures four (4) inches 
transversely, and is about two (2) inches thick; in structure 
it resembles the cerebrum to the extent that it has a cortex 
which is made up of cells (gray matter), surrounding a 
white center consisting of nerve fibers, and which also con- 
tains a special nucleus, the corpus dentatum. The cere- 
bellum is connected with the mid-brain (mesencephalon) by 
the superior peduncles, with the pons (epencephalon) by the 
middle peduncles, and with the medulla (metencephalon) by 
the inferior peduncles. 



ANATOMY. 443 

Describe the trachea and give its anatomical relation. 

It. extends from the larynx to the bronchi, and consists of 
a series of transversely directed, incomplete rings of carti- 
lage united by an elastic membrane which contains involun- 
tary muscle-fiber posteriorly, where the cartilaginous ring 
is deficient; it is lined with a mucous membrane which is 
covered with ciliated columnar epithelial cells. 

The trachea rests upon the esophagus, being flattened 
posteriorly ; in the groove between these two structures is the 
recurrent laryngeal nerve, upon each side ; the common carotid 
artery, internal jugular vein and pneumogastric nerve are 
close to it at its lower portion, while the isthmus of the 
thyroid body crosses it upon its second and third rings, and 
the lobes of the same rest upon it laterally. 

Give the number and name the bones forming the skull. 

There are 22 bones in the skull : Cranium, 8 bones, viz., 
occipital, 2 parietal, frontal. 2 temporal, sphenoid, ethmoid. 
Face 14 bones, viz., 2 nasal, 2 superior maxillary, 2 lachrymal, 
2 malar, 2 palate, 2 inferior turbinated, vomer, inferior 
maxillary. 

Give the origin, insertion, action and nerve supply of 
the gastrocnemius muscle. 

Arises by 2 heads from the posterior surface of the condyles 
of the femur and adjacent part of the shaft; inserted by tendo 
Achillis into os calcis; action, to extend foot upon leg; nerve 
supply, internal popliteal. 

w What structures pass through the foramen magnum? 

Spinal cord, meninges, spinal accessory nerves (2), verte- 
bral arteries (2), anterior and posterior spinal arteries. 

Name and give the origin and insertion of the muscles 
which depress the lower jaw. 

Genio-hyoid. from inferior genial tubercle of mandible be- 
hind symphysis into body of hyoid bone ; mylo-hyoid, from 
mylo-hyoid ridge of mandible, into body of hyoid bone; an- 



444 ANATOMY. 

terior belly of digastric, origin from inner surface of mandi- 
ble, near symphysis, into central tendon, attached to body of 
hyoid bone. 

Give the blood supply of the tonsils. 

Ascending pharyngeal, tonsillar branch of dorsalis linguae, 
ascending palatine and tonsillar branches of facial, and de- 
scending palatine branch of internal maxillary. 

4__ Mention the branches of the facial artery. 

Tonsillar, ascending palatine, muscular, glandular, sub- 
mental, inferior labial, inferior and superior coronary, lateral 
nasal, angular. 

Describe the mandible. 

The mandible, or inferior maxillary bone, consists of a 
horseshoe-shaped body which corresponds in shape with the 
alveolar border of the upper jaw, and extends upward and 
backward on either side as a ramus, which is surmounted by 
a coronoid process and a condyle, separated from each other 
by the sigmoid notch. The anterior extremity of the body 
projects as the mental protuberance (a characteristic of the 
human jaw), and the posterior end of the body, where it 
joins the ramus, is called the angle. Just anterior to this 
angle is a groove for the facial artery; the alveolar process, 
or border, contains sockets for the teeth, and is relatively 
thicker in the child's jaw, than in the adult's; behind the 
symphysis are the genial tubercles, while laterally from these 
are the depressions for the digastric muscles; more posteriorly 
still are the shallow fossae for the submaxillary glands ; upon 
the inner surface of the body, running downward and for- 
ward, is the mylo-hyoid ridge, for the mylo-hyoid muscle ; the 
ramus is roughened externally for the masseter, and inter- 
nally for the internal pterygoid muscle ; upon the inner 
surface of the ramus is the inferior dental foramen, which 
leads into a canal of the same name ; to the coronoid process 
is attached the temporal muscle, while the condyle articu- 
lates with glenoid fossa of the temporal bone. 



ANATOMY. 445 

Describe the hyoid bone. 

Is placed transversely above the thyroid cartilage, con- 
sisting of a centrally located body connected laterally with 
two greater wings, and supporting, at the junction of the 
body and greater wing, on each side, the lesser wing. The 
hyoid bone supports the tongue and has twenty muscles at- 
1 ached to it. 

Describe the ethmoid bone. 

The ethmoid bone is a light spongy bone consisting of a 
central portion and two lateral masses. The central part 
presents a horizontal plate, perforated for the transmission 
of olfactory nerve filaments, hence called cribriform. Pro- 
jecting upward from the anterior median portion of the 
horizontal plate is the crista galli, serving for the attachment 
of the falx cerebri. From the under surface of the cribriform 
plate depends the perpendicular plate, which forms part of 
the nasal septum. The lateral mass, on each side, consists of 
two curling pieces of bone, the superior and middle turbinals, 
attached to the ethmoidal cells, which are limited exter- 
nally by a smooth plate called the os planum, which 
assists in the formation of the inner wall of the orbit, De- 
scending from the lateral mass is the unciform process which 
articulates with the inferior turbinated bone, and assists in 
forming part of the inner wall of the antrum of Highmore. 

Give origin, insertion and action of the buccinator 
muscle. 

Origin, from the alveolar processes of the superior and 
inferior maxillary bones, and behind, from the pterygo- 
maxillary ligament. Its superior fibres blend with the fibres 
of the orbicularis oris in the lower lip, its inferior fibres 
with the fibres of the orbicularis oris muscle in the upper 
lip. Its action is to assist in keeping the food between the 
teeth in mastication ; it is used in such acts as whistling and 
in blowing a trumpet. 



446 ANATOMY. 

What nerve supplies the muscles of expression? 

The facial, or seventh cranial nerve. 
L What nerve supplies the muscle of mastication? 

Branches of the inferior maxillary division of the fifth 
cranial nerve. 

Mention the muscles attached to the occipital bone. 

Twelve pairs: Occipito-frontalis, sternoinastoid, trapezius, 
splenius capitis et colli, coniplexus, obliquus capitis superior, 
rectus capitis anticus major and minor, rectus capitis posticus 
major and minor, rectus capitis lateralis and superior con- 
strictor of pharynx. 

Give the course and relations of the external jugular 
vein. 

It begins in the lower part of the parotid gland, on a level 
with the angle of the mandible, and courses downward from 
the angle of the jaw to the middle of the clavicle; it crosses 
the sterno-mastoid muscle, lies beneath the platysma myoides, 
and terminates in the subclavian vein. 

Name the three classes of articulations. 

Synarthrosis, amphiarthrosis and diarthrosis. 
What nerves pass through the sphenoidal fissure? 

The third, fourth, ophthalmic division of the fifth, and the 
sixth cranial nerves. 

'V Give the origin, insertion, nerve supply, and action of 
the pterygoid muscles. 

The external pterygoid muscle arises by two heads. The 
upper head arises from the inferior surface of the great wing 
of the sphenoid below the pterygoid ridge, the lower from 
the outer surface of the external pterygoid plate. Its fibers 
pass horizontally backward and outward to be inserted into 
the depression in front of the neck of the condyle of the 
lower jaw, and into the interarticular fibro-cartilage. 

Internal pterygoid muscle arises from the pterygoid fossa 



ANATOMY. 447 

and is inserted into the inner surface of the ramus and angle 
of the lower jaw. 

Nerve supply, mandibular division 5th cranial. Action, 
both external pterygoids throw lower jaw forward, while 
each, acting alternately, produces triturating movement; in- 
ternal pterygoids bring lower jaw up against upper jaw, and 
assist external pterygoids in carrying jaw forward. 

Mention the arteries from which the superior maxillary 
bone derives its blood supply. 

Alveolar, anterior and middle dental, branches of infra- 
orbital, and spheno-palatine and posterior palatine, branches 
of internal maxillary. 

Describe the salivary glands. Where do these glands 
empty? 

Parotid, submaxillary, sublingual. Parotid, largest, placed 
in front of ear, behind ramus of mandible; duct (Steno's) 
passes across masseter muscle, perforates buccinator muscle, 
terminates in cheek wall opposite upper middle molar. 
Parotid gland has facial nerve, external carotid artery, 
temporo-maxillary vein passing through it. 

Submaxillary gland is located upon inner side of body of 
mandible posteriorly, and is crossed by facial artery; duct 
("Wharton's) passes forward, terminating close to fraenum 
linguae. 

Sublingual gland, located in shallow fossa upon inner side 
of body of mandible, near symphysis, is covered by mucous 
membrane of mouth; ducts (of Rivinus and Bartholin) 
terminate near fraenum linguae. 

What bones enter into the formation of the orbital 
cavities? 

Frontal, sphenoid, ethmoid (3 singles) ; lachrymal, su- 
perior maxillae, malar, palate (4 pairs). 

Describe the frontal bone and give its articulations. 

The vertical portion forms the forehead, is convex ex- 



I 



448 ANATOMY. 

ternally, presents two slightly raised eminences, the frontal, 
one to either side of the median line, while below them are 
the superciliary ridges, and below the latter, the supra-orbital 
arches, which terminate externally and internally in the ex- 
ternal and internal angular processes, respectively. Each 
supra-orbital arch presents the supra-orbital notch, or fora- 
men, at the junction of its inner and middle thirds. Between 
and below the two superciliary ridges is the glabella; the 
lateral segment of the vertical portion forms part of the tem- 
poral fossa, and the temporal ridge has its beginning in the 
external angular process, curving upward and backward. 
Upon the inner surface of the vertical portion are irregulari- 
ties corresponding to cerebral convohvtions ; longitudinally 
placed is the groove for the superior longitudinal sinus. 

The horizontal portion is composed of the two thin orbital 
plates, separated from each other by the ethmoidal notch, 
which is filled in by the ethmoid bone ; these plates are smooth 
and concave underneath, but irregularly convex above. 

Frontal bone articulates with both parietals, both malars, 
both nasals, both lachrymals, both maxillae, and with the 
ethmoid and sphenoid. 

Describe the temporal bone. 

Is made up of 3 divisions, squamous, mastoid and petrous. 

Squamous bone has vertically placed scale-like plate which 
forms large part of temporal fossa externally and of middle 
cerebral fossa internally; zygomatic process curves forward 
from it, while beneath is the glenoid fossa for condyle of man- 
dible, located just behind eminentia articularis, and in front 
of tympanic plate (anterior wall of tympanum and external 
auditory canal) . 

Mastoid bone is placed behind, is rough and convex ex- 
ternally and projects downward and forward as mastoid pro- 
cess; beneath are digastric fossa for posterior belly of digas- 
tric muscle, and occipital groove for occipital artery, within 
substance of mastoid are mastoid cells, the largest of which 



ANATOMY. 449 

is called mastoid antrum, which communicates with middle 
ear; upon cerebral surface of mastoid is sigmoid groove for 
lateral sinus. 

Petrous bone is pyramidal and is wedged in between squa- 
mous and mastoid bones; base presents oval opening, the 
external auditory meatus, to rough edge of which (auditory 
process) auricle is attached; apex, directed forward and in- 
ward, is notched to help form middle lacerated foramen, for 
entrance of internal carotid artery into cranial cavity ; cranial 
aspect of petrous bone forms ridge for attachment of dura 
(tentorium), a depression near apex for Gasserian ganglion, 
and upon posterior surface, the internal auditory meatus, 
for auditory and facial nerves; petrous bone forms bony part 
of external auditory canal, the middle ear, and contains the 
osseous labyrinth ; upon its under surface are to be found, 
near the center, the beginning of the carotid canal, behind 
and to the outer side of which is the jugular fossa, which, 
with a notch on the occipital bone, completes the jugular 
foramen; the styloid process, surrounded by the vaginal pro- 
cess at its base, may be seen projecting downward, forward 
and inward ; the stylo-mastoid foramen, giving entrance to 
the stylo-mastoid artery and exit to the facial nerve, is to be 
found between the styloid and mastoid processes. 

Temporal bone articulates with 5 bones : occipital, parietal, 
sphenoid, malar and mandible. 

/ Describe the ophthalmic artery. 

Is a branch of internal carotid, given off just, after carotid 
has left cavernous sinus; it enters orbit by passing through 
the optic foramen, courses toward internal angular process 
where it divides into frontal and nasal. Branches are lachry- 
mal, ciliary, arteria centralis retinae, muscular, anterior and 
posterior ethmoidal, palpebral and supra-orbital. 

2 Describe the pulmonary veins. 

They are four in number, usually, 2 for each lung, and 
return arterial blood from lungs to left auricle of heart. 
29 



450 ANATOMY. 

I Describe the otic ganglion. 

Is a small, flattened ganglion situated immediately beneath 
foramen ovale; it receives motor and sensory roots from 
mandibular division of the 5th cranial; the small superficial 
petrosal nerve also enters it, furnishing branches of com- 
munication from the glosso-pharyngeal (sensory) and facial 
(motor) ; the sympathetic fibers come from the middle menin- 
geal plexus. Its branches of distribution are to the tensor 
tympani and tensor palati muscles, and to the chorda tym- 
pani nerve. 

Give a brief description of the facial nerve. 

The 7th cranial nerve, after passing through facial canal 
(aquaeductus Fallopii) of temporal bone, emerges at the 
stylo-mastoid foramen, and enters substance of parotid gland. 
Here it divides into 2 sets of branches, temporo-facial and 
cervieo-facial, supplying muscles of expression. Its chorda 
tympani branch traverses inner surface and membrana tym- 
pani, after leaving main trunk in facial canal, and emerging 
through one end of the Glaserian fissure unites with lingual 
branch of 5th and accompanies it to submaxillary gland and 
ganglion and anterior % of mucous membrane of tongue. 

Describe the hypoglossal nerve. 

The 12th cranial nerve leaves cranial cavity by anterior 
condyloid foramen and descends almost vertically to a point 
corresponding with angle of jaw; it loops around occipital 
artery, then lies above hyoid bone, supplying intrinsic muscles 
of tongue. A communication from 1st and 2d cervical nerves 
after uniting with hypoglossal, leaves it to form deseendens 
hypoglossi, branches from which are distributed to extrinsic 
muscles of tongue and depressors of hyoid bone. 

Describe the nasal bone and give its articulations. 

It forms "the bridge" of the nose, is oblong in shape, con- 
cave longitudinally, convex transversely ; is grooved pos- 
teriorly for branch of nasal nerve ; upper margin is thick and 



ANATOMY. 451 

serrated, while lower is thin, and notched ; upper margin arti- 
culates with frontal bone, while lower has lateral cartilage of 
nose attached to it. It articulates with frontal, ethmoid, 
maxilla and opposite nasal. 

Mention the muscles attached to the temporal bone. 

Fifteen, viz. : temporal, masseter, occipito-f rontalis, sterno- 
mastoid, splenius capitis, trachelo-mastoid, digastric, re- 
trahens, aurem, stylo-pharyngeus, stylo-hyoid, stylo- glossus, 
levator palati, tensor tympani, tensor palati, and stapedius. 

Give origin and insertion of each of the muscles of the 
palpebral region. 

Three : orbicularis palpebrarum, corrugator supercilii and 
levator palpebrae. Orbicularis palpebrarum : origin, internal 
angular process of the frontal bone, and nasal process of the 
superior maxilla ; passes outward around the circumference 
of the orbit and is inserted, some fibres into the tarsal liga- 
ments, others forming a complete ellipse ; the remaining 
fibres blend with the surrounding muscles. 

Corrugator supercilii : origin, from the inner extremity of 
the superciliary ridge, passing out to be inserted into the 
skin. 

Levator palpebrae : origin, the under surface of lesser wing 
of sphenoid above and in front of optic foramen. It passes 
outward along the roof of the orbit, becomes aponeurotic, 
and is inserted into the upper margin of the superior tarsal 
plate. 

yj Describe the superior longitudinal sinus. 

It extends from the crista galli of ethmoid to internal occi- 
pital protuberance of occipital; it increases in size as it is 
traced backward, draining the cortex of the cerebral hemi- 
spheres of venous blood. It usually becomes continuous 
with right lateral sinus. 



•f 



Describe the subclavian vein. 

A continuation of the axillary, it extends from outer bor- 



452 ANATOMY. 

der of 1st rib to near sterno-elavicular joint, where it unites 
with internal jugular to form innominate vein (brachio- 
cephalic). It is anterior to subclavian artery, on 1st rib 
separated from the artery by anterior scalene muscle. Its 
tributaries are external and anterior jugular veins; the left, 
at its point of junction with the internal jugular, receives 
the thoracic duct. 

/ Describe the submaxillary ganglion. 

Small in size, is situated upon deep portion of submaxillary 
salivary gland; is connected with lingual (gustatory) nerve, 
and receives a branch from chorda tympani of facial ; it com- 
municates with sympathetic plexus around facial artery. 
Branches of distribution are to mucous membrane of mouth 
and Wharton's duct. 

T^- Describe the ophthalmic nerve. 

1st division of 5th, is entirely sensory. It arises from 
Gasserian ganglion, and before passing through sphenoidal 
fissure into orbit, divides into 3 branches, viz., lachrymal, 
frontal, nasal. 

Lachrymal supplies lachrymal gland, conjunctiva and up- 
per eyelid. 

Frontal, largest branch, divides into supratrochlear and 
supra-orbital, supplying skin of upper eyelid and of fore- 
head, and integument and pericranium over half of head as 
far as occiput. 

Nasal branch leaves orbit by anterior ethmoidal foramen, 
enters nose and supplies mucous membrane of nose and 
integument covering ala. 



\ 



Name the arteries and nerves of the gums. 

Arteries are branches of internal maxillary, anastomosing 
with branches of facial artery through cheek wall. Nerves 
are from maxillary and mandibular divisions of 5th cranial, 
and branches from Meckel's ganglion. 



ANATOMY. 453 

What bones encase the brain and what is their relative 
position? 

Occipital, both parietals, frontal, both temporals, sphenoid 
and ethmoid. Occipital is behind and below, parietals are 
above and at the sides, frontal is anterior, temporals are be- 
neath and at the sides, sphenoid and ethmoid are beneath, 
anteriorly. 

Describe the spinal column. 

It consists of 33 separate vertebrae, distributed as follows : 
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal. Sacral 
and coccygeal coalesce early in life by ossification of inter- 
vertebral substances; cervical segment possesses curve with 
convexity forward, thoracic with convexity backward, lumbar 
with convexity forward, sacral with convexity backward; 
line of gravity passes through chords of these curves. 
Special, or peculiar, vertebrae are: atlas, axis, 7th cervical 
(vertebra prominens) ; ribs articulate with thoracic series; 
ilia articulate with sacrum. Spinal column contains neural 
canal for spinal cord. 

What are tendons and their function? 

They are rounded (cord-like) or narrow (ribbon-like) 
bundles of white fibrous tissue attaching muscles to bones or 
forming ligaments of joints, (shoulder, hip). 

Describe the elbow=joint and the manner of its lubri- 
cation. 

Is a ginglymus, or hinge-joint, made up of lower end of 
humerus and upper ends of radius and ulna: head of radius 
articulates with capitellum, and greater sigmoid cavity of 
ulna with trochlear surface of humerus. Its capsule is 
divided into anterior and posterior, internal and external 
lateral ligaments. It permits of flexion and extension. It is 
lubricated by synovial membrane lining its capsule. 

Describe the knee=joint and its manner of lubrication. 

Trochlear surface of condyles of femur, upper surfaces of 



% 



4 



454 ANATOMY. 

tuberosities of tibia, and posterior surface of patella form its 
bony parts. These are completely surrounded by a capsule 
which is strengthened antero-laterally by aponeurotic inser- 
tions of vastus externus and internus and by fascia lata; 
externally by a special band, or thickening, the external 
lateral ligament, and internally by the internal lateral liga- 
ment; posteriorly by the reflected tendon of the semimem- 
branosus muscle. 

Internal ligaments are anterior and posterior crucial, be- 
tween intercondyloid notch of femur and non-articular sur- 
face around spine of tibia; also 2 semilunar fibro-cartilages, 
attached to spine of tibia, while the internal is also attached 
to internal lateral ligament. 

Synovial membrane is large, lines capsule and is reflected 
into interior of joint around crucial ligaments, its folds here 
containing fatty tissue ; it is extended upward beneath quad- 
riceps tendon. 

What muscles are involved in respiration? 

Diaphragm, external and internal oblique, transversalis 
and rectus, of abdominal walls, external and internal inter- 
costals, serratus posticus superior and inferior. 

Give the muscles of facial expression. 

Occipito-frontalis, corrugator supercilii, orbicularis palpe- 
brarum, levator labii superioris alaeque nasi, levator labii 
superioris, levator anguli oris, zygomaticus major and minor 
orbicularis oris, depressor anguli oris, depressor labii inferioris 
and platysma myoides. 

Describe the joint in which the mandible works and 
the tissues constituting the joint. 

Bony parts are glenoid fossa and articulating eminence of 
temporal bone, and condyle of mandible; ligaments form a 
capsule, much stronger externally and posteriorly; external 
lateral ligament extends between tubercle of zygoma and neck 
of condyle ; associated ligamentos bands are spheno-mandi- 
bular and stylo-mandibular ; an interarticular cartilage con- 



ANATOMY. 455 

tained within the joint cavity has tendon of insertion of ex- 
ternal pterygoid muscle attached to it. Movements per- 
mitted are depression and elevation of jaw around a trans- 
verse axis, and a sliding forward of both sides, protruding 
chin, or of one side at a time, producing a triturating 
movement. 

Name the bones of the head and face and give the ar= 
ticulations of the maxilla. 

Cranium: occipital, 2 parietal, frontal, 2 temporal, sphe- 
noid, ethmoid. Face: 2 Lachrymal, 2 malar, 2 nasal, 2 
maxillae, 2 palate, 2 inferior turbinated, vomer, mandible. 

Maxilla articulates with 9 bones : Frontal, ethmoid, nasal, 
lachrymal, malar, palate, inferior turbinated, vomer and op- 
posite maxilla. 

Describe the shou!der=joint. 

Variety, enarthrodial (ball-and-socket) ; bones, glenoid 
fossa of scapula, head of humerus ; ligament, capsular, which 
is intimately blended with tendons of insertion of sub- 
scapularis, supraspinatus, infraspinatus and teres minor 
muscles; tendon of long head of biceps passes within capsule 
over humeral head, and is surrounded by synovial mem- 
brane ; movements, flexion, extension, abduction, adduction, 
rotation and circumduction. 

"A Describe the superior maxillary bone. 

Consists of body and nasal, alveolar, palatal, and malar 
processes. 

Body is irregularly cuboidal, contains cavity called maxil- 
lary sinus (antrum of Highmore), which is lined with 
mucous membrane in recent state ; its external surface pres- 
ents eminences corresponding to roots of teeth, also incisive 
fossa, near median line, and canine fossa, to outer side of 
canine eminence; above canine fossa is infra-orbital foramen, 
the termination of infra-orbital canal which traverses orbital 
surface ; posterior, or zygomatic, surface is convex and forms 



456 ANATOMY. 

part of zygomatic fossa; it presents orifices of posterior dental 
canals, for dental vessels and nerves; internal surface is ir- 
regular, contains turbinated crest for articulation of inferior 
turbinated bone, groove for naso-lachrymal duct and helps to 
form outer wall of nasal meati. 

Maxillary sinus (antrum of Highmore) is large, pyramidal, 
has thin walls, opens into middle meatus of nose by aperture 
which is narrowed by articulating with ethmoid above, in- 
ferior turbinated below and palate bone behind. 

Nasal process projects upward, forming lateral wall of 
nose, articulating with nasal, frontal and lachrymal bones; 
alveolar process is thick, spongy and contains alveoli (8 in 
number) for teeth; malar process is thick, rough and ser- 
rated for articulation with malar bone ; palate process is di- 
rected horizontally inward and articulates with fellow of 
opposite bone and with palate bone behind; its superior sur- 
face is smooth and slightly concave from side to side, form- 
ing floor of nasal chamber, and rough beneath, where it con- 
stitutes roof of mouth ; at anterior end of it is to be found 
anterior palatine canal, situated in median line. 

Give origin, insertion, action and nerve supply of the 
omo=hyoid muscle. 

Origin from superior border of scapula and occasionally 
from suprascapular ligament; insertion into body of hyoid 
bone; beneath sterno-mastoid it develops a central tendon 
which is held down to 1st rib and clavicle by a process of 
deep cervical fascia ; action, to depress hyoid bone and to 
support soft parts of neck during prolonged or difficult in- 
spiratory efforts by making tense the cervical fascia; nerve 
supply, cervical nerves through descendens and communi- 
cans hypoglossi. 

Give the origin, insertion, action and nerve supply of 
the genio=hyo=glossus muscle. 

Origin, superior genial tubercle of mandible ; insertion, into 
deep part of tongue close to median septum, or raphe, from 



ANATOMY. 457 

tip to base, and into body of hyoid bone; action, to protrude 
base and retract tip, and to make tongue concave trans- 
versely; nerve, hypoglossal. 

Describe the superior thyroid artery. ■ 

Branch of external carotid formed just ahove thyroid carti- 
lage, curves inward and downward, giving off hyoid, mus- 
cular, superior laryngeal, crico- thyroid and glandular branches 
to interior and exterior of larynx and to thyroid gland. 

Describe the mylohyoid nerve. 

Is a branch of inferior dental nerve given off just as the 
latter is about to enter inferior dental canal ; mylo-hyoid nerve 
passes forward and downward in groove on inner surface of 
body of mandible, and supplies mylo-hyoid and anterior belly 
of digastric muscles. 

<r Describe the os planum. 

Is a smooth, horizontally oblong plate of bone forming 
outer boundary of lateral mass of ethmoid and part of inner 
wall of orbit ; it articulates with frontal above, lachrymal 
anteriorly, maxilla below and with sphenoid and palate bone 
posteriorly. 

Mention the number of points of ossification of the in = 
ferior maxillary bone, and describe its development. 

Five centers of ossification. 

Is developed chiefly in membrane, but partly from cartilage, 
ossification commencing earlier than in any other bone except 
clavicle. Most of the bone is formed from center of ossifica- 
tion which appears between 5th and 6th week in membrane on 
outer surface of Meckel's cartilage; 2d center appears on in- 
ner surface of Meckel's cartilage and develops into inner 
wall of tooth-sockets; anterior extremity of Meckel's cartilage 
ossifies and forms body of jaw ; separate centers appear in con- 
dyle, coronoid process and angle. At birth mandible con- 
sists of 2 halves united by a fibrous symphysis, which ossi- 
fies during 1st year. 



i 



458 ANATOMY. 

Give origin, insertion, action and nerve supply of di- 
gastric muscle. 

Origin, posterior belly from digastric groove on under sur- 
face of mastoid portion of temporal, anterior belly from inner 
surface of mandible near symphysis ; posterior belly extends 
downward and forward, anterior belly extends downward and 
backward, both to be inserted into a central tendon which 
perforates tendon of insertion of stylo-hyoid and is held to 
hyoid bone by fibrous loop. Action, raises tongue, in deg- 
lutition, and when hyoid bone is fixed by its depressors the 
digastric will depress lower jaw. Nerve supply : anterior 
belly by mylo-hyoid branch of inferior dental, posterior belly 
by facial nerve. 

Mention the muscles of mastication and give their origin 
and insertion. 

Temporal : origin, from temporal fossa between temporal 
ridge above and pterygoid ridge below, and from external 
angular process of frontal to mastoid process of temporal, 
also from inner surface of temporal fascia; into coronoid pro- 
cess of mandible. 

External pterygoid : origin, by two heads, upper from under 
surface of great wing of sphenoid, lower from outer surface 
of external pterygoid plate; insertion into neck of condyle 
of mandible and interarticular fibro-cartilage of temporo-man- 
dibular joint. 

Internal pterygoid: origin, from pterygoid fossa; inser- 
tion into inner surface of angle and ramus of mandible as 
high as dental foramen. 

Masseter: origin, from malar process of maxilla and lower 
border and inner surface of zygomatic arch ; insertion into 
external surface of ramus of mandible. 

\ Mention the muscles attached to the hyoid bone. 

Genio-hyo-glossus, genio-hyoid, mylo-hyoid, stylo-hyoid, 
aponeurosis of digastric, hyo-glossus, middle constrictor of 
pharynx, sterno-hyoid. thyro-hyoid, omo-hyoid. 



ANATOMY. 459 

I Describe the aorta. 

Springs from left ventricle, anteriorly, extends upward 
to upper border of right 2d costal cartilage, then arches 
backward to left and descends through thorax, resting upon 
vertebral bodies, passes through aortic opening in diaphragm 
and courses through abdominal cavity as far as body of 4th 
lumbar vertebra. 

Branches are 2 coronary from ascending portion ; innomin- 
ate, left common carotid and left subclavian from arch ; bron- 
chial, intercostal, pericardiac, esophageal and posterior medi- 
astinal from thoracic portion; 2 phrenic, lumbar, sacra media 
(parietal branches), coeliac axis (gastric, hepatic, splenic), 
superior mesenteric, inferior mesenteric (single branches from 
front), suprarenal, renal, spermatic (or ovarian) (lateral 
paired branches) from abdominal portion. 

Z— Describe the superior vena cava. 

Is formed by union of right and left innominate (jugulo- 
cephalic) veins, just below cartilage of 1st rib (close to 
right border of sternum ; is nearly 3 inches long and ter- 
minates in right auricle ; it receives vena azygos major. 

yf. Describe the fissure of Rolando. 

It is boundary line between frontal and parietal lobes of 
brain, extending from point at or near great longitudinal 
fissure just behind midpoint between anterior and posterior 
poles of cerebrum, downward and forward at angle of 67° 
with the sagittal axis, for a distance of 3% inches. Ascend- 
ing frontal convolution forms its anterior wall, and ascend- 
ing parietal convolution its posterior wall. 

tf Describe the inferior maxillary nerve. 

Motor root of 5th cranial unites with 3d branch of 
Gasserian ganglion to pass through foramen ovale, then to 
divide into an anterior and a posterior trunk ; anterior, smaller 
and mostly motor, is distributed to muscles of mastication; 
posterior, mostly sensory, divides into auriculotemporal, 
lingual and inferior dental. 



^ ks-s 




460 ANATOMY. 

I Mention the muscles attached to the sphenoid bone. 

Temporal, external pterygoid, internal pterygoid, superior 
constrictor, tensor palati, levator palpebrae superioris, su- 
perior, inferior, internal and external recti, and superior 
oblique. 

f Describe the Vidian nerve. 

Begins in cartilage filling up middle lacerated foramen 
by union of large superficial petrosal (branch of facial) with 
large deep petrosal (from carotid plexus), passes forward 
through Vidian canal to enter spheno-maxillary fossa, here 
joining Meckel's ganglion. 

Mention the branches of the occipital artery. 

Muscular, sterno-mastoid, auricular, meningeal and artena 
princeps cervicis. 

fi Describe the palato=glossus muscle. Give origin, in- 
/ sertion and nerve supply. 

Origin, anterior surface of soft palate close to uvula; in- 
sertion, into side and substance of tongue; action, to con- 
strict fauces and retract tongue; nerve supply branch of 
spinal accessory. 

Describe the internal jugular vein. 

Is formed just below jugular foramen by lateral and in- 
ferior petrosal sinuses; courses down neck beneath anterior 
border of sterno-mastoid muscle in a common sheath with in- 
ternal carotid (above), common carotid (below), and pneu- 
mogastric nerve, the latter behind and between, and the 
artery to the inner side of the vein, which partially overlaps 
the artery. Behind sternal end of clavicle it unites with sub- 
clavian to form innominate vein. Its tributaries are facial, 
lingual, pharyngeal, superior and middle thyroid veins and 
sometimes the occipital vein. 

What muscles control the soft palate? 

Tensor palati and levator palati, azygos uvulae, palato- 
glossus and palato-pharyngeus. 



ANATOMY. 461 

/ What are the terminal branches of the external carotid 
artery? 

Superficial temporal and internal maxillary. 
,, Describe the maxillary sinus (or antrum of Highmore). 

Is a triangular cavity contained in body of maxilla, lined 
with mucous membrane and communicating with middle 
meatus of nose through one or two small openings; apex of 
cavity is formed by malar process of maxilla ; base is formed 
by outer wall of nose ; in its posterior wall are posterior 
dental canals for posterior dental vessels and nerves to the 
teeth ; in floor are usually seen several elevations, correspond- 
ing to roots of 1st and 2d molar teeth. 

What forms the circle of Willis? 

The 2 internal carotids, 2 anterior cerebrals connected by 
anterior communicating, 2 posterior communicating and 2 
posterior cerebrals. 

[L Describe the gustatory (lingual) nerve. 

Is a branch of posterior trunk of mandibular division of 
5th cranial, lying deeply placed beneath external pterygoid 
muscle where it is joined by chorda tympani nerve from 
facial ; it takes a deep course until it gets beneath mucous 
membrane of floor of mouth, where it is distributed to 
papillae and mucous membrane of anterior % of tongue. 

What are the articulations of the malar bone? 

With 4 bones: frontal, sphenoid, temporal and maxilla. 
Name articulations of the occipital bone. 

With 6 bones: two temporal, two parietal, sphenoid and 
atlas. 

Describe the inferior dental artery and name its 
branches. 

Is a branch of the 1st division of the internal maxillary 
artery, passing into inferior dental canal at dental foramen, 
accompanied by inferior dental nerve, coursing along inferior 



462 ANATOMY. 

dental canal to mental foramen, opposite 1st bicuspid tooth, 
where it divides into an incisor and a mental branch. The 
former remains within the jaw to supply the anterior teeth, 
anastomosing at symphysis with the incisor branch of the 
opposite side, while the latter escapes at the mental foramen 
to supply chin structures. 

Branches are: lingual, accompanying lingual nerve to 
mucous membrane of floor of mouth ; mylo-hyoid, accompany- 
ing mylo-hyoid nerve to mylo-hyoid muscle; branches which 
enter pulp cavities at apices of roots; terminal branches, 
incisor and mental. 

What artery supplies the tongue with blood? 

Lingual. (The principal one). 
^ Name the articulations of the temporal bone. 

Occipital, parietal, sphenoid, malar and mandible. 
\ Name the muscles of the tongue and their attachments. 

Intrinsic : divisions of lingualis. Extrinsic : genio-hyo- 
glossus, hyo-glossus, stylo-glossus, palato-glossus. 

Lingualis consists of superior lingualis (longitudinal fibers), 
transverse lingualis, inferior lingualis and vertical lingualis. 
These bundles and strata of muscular fibers intersect each 
other, being attached to under surface of mucous membrane 
and to raphe. 

Genio-hyoglossus, origin superior genial tubercle ; inser- 
tion deep surface of tongue and body of hyoid bone. Hyo- 
glossus, origin body, greater and lesser cornua of hyoid; in- 
sertion side of tongue. Stylo-glossus, origin styloid process; 
insertion side of tongue. Palato-glossus, origin anterior sur- 
face of soft palate; insertion side of tongue. 

Describe the lingual artery and give its branches. 

Is a branch of external carotid, formed near greater cornu 
of hyoid bone, runs in curved manner forward to beneath 
hyo-glossus muscle, then in tortuous course to tip of tongue 
under name of ranine artery. Branches are, hyoid, dorsalis 
linguae, sublingual, ranine. 



ANATOMY. 463 

Describe the occipito=frontalis. 

Arises from outer % of superior curved line of occipital 
bone and from mastoid bone as posterior belly which blends 
with centrally placed aponeurosis on vertex, which is con- 
tinued forward into anterior belly, the latter being united 
to tbe orbicularis palpebrarum, corrugator supercilii and 
pyramidalis nasi. Action, to raise brows, produce transverse 
wrinkles of forehead and move scalp backward and forward. 

What muscles control the eye? 

Superior, inferior, internal and external recti ; superior and 
inferior oblique. 

Which artery is the longer, the external or the internal 
carotid? 

Internal carotid. 

Mention the muscles of the pharynx. 

Superior, middle and inferior constrictors (2 each), palato- 
pharyngeus and stylo-pharyngeus. 

Describe (a) facial vein, (b) the internal maxillary vein. 

Facial vein begins by an anastomosis with angular vein 
near inner canthus, passes downward and outward diagonally 
across face, turns over body of mandible in front of masseter 
muscle and unites with branch from temporo-maxillary vein 
to form common facial, this, in turn, emptying into internal 
jugular. 

Internal maxillary vein accompanies artery of the same 
name, receiving tributaries which correspond to branches of 
the artery, and communicating freely with facial vein and 
cavernous sinus (through foramen ovale and middle lacer- 
ated foramen). Internal maxillary vein then unites with tem- 
poral vein, forming temporo-maxillary vein. 

Give the branches of the external carotid artery. 

Ascending pharyngeal, superior thyroid, lingual, facial, 
posterior auricular, occipital, temporal and internal maxillary. 



464 ANATOMY. 

What muscles have their origin from the styloid process? 

Stylo-glossus, stylo-hyoid, stylo-pharyngeus. 

Give the origin and insertion of the sterno=mastoid 
muscle. 

Origin, by 2 heads, one from inner third of superior border 
of clavicle, the other from front of manubrium sterni ; in- 
sertion into mastoid process and outer % of superior curved 
line of occipital bone. 

£ Describe the tensor palati. 

Origin from scaphoid fossa of sphenoid and margin of 
Eustachian tube, extends downward, has tendon which hooks 
round hamular process of internal pterygoid plate, then to 
be inserted into aponeurosis of soft palate and into hori- 
zontal portion of palate bone. 

// What bones articulate with the vomer? 

Sphenoid, ethmoid, 2 palate, 2 maxillae. 
Describe the sphenoidal fissure. 

Is located between orbital and cranial cavities, a triangu- 
lar gap between the greater and lesser wings of sphenoid 
bone. Its inner end is broad and rounded, its outer, narrow 
and pointed ; its long axis extends outward, forward and 
upward. It transmits the 3d, 4th, the 3 branches of the 
ophthalmic division of the 5th cranial nerves, and the oph- 
thalmic vein. 

Describe the glenoid fossa. 

Is found upon under surface of temporal bone behind arti- 
culating eminence and in front of tympanic plate; is crossed 
by Glaserian fissure; posterior part receives upper end of 
parotid gland and anterior part receives condyle of mandible. 

What nerve and artery pass through the foramen ovale 
of the sphenoid bone? 

Mandibular division of 5th cranial; small meningeal 
branch of internal maxillary artery. 



ANATOMY. 465 

Mention the muscles attached to the inferior maxillary 
bone. 

Fifteen pairs : levator inenti, depressor labii inferioris, de- 
pressor anguli oris, platysma myoides, buccinator, masseter, 
orbicularis oris, genio-hyoglossus, genio-hyoid, mylo-hyoid, 
digastric, superior constrictor, temporal, internal and external 
pterygoids. 

* Mention the principal veins of the head and neck. 

Frontal, angular, facial, internal maxillary, temporo-maxil- 
lary, ophthalmic ; superior longitudinal, inferior longitudinal, 
straight, lateral, occipital, superior and inferior petrosal, 
transverse, circular and cavernous sinuses ; external, anterior 
and internal jugular vertebral veins. 



i 



f 



What muscles are attached to the basilar process of the 
occipital bone? 

Rectus capitis anticus major and minor, and superior con- 
strictor of pharynx. 

Give the boundary of the anterior triangle of the neck. 

Is bounded anteriorly by line extending from chin to 
sternum ; behind by anterior margin of sterno-mastoid muscle ; 
above by lower border of body of mandible and line extended 
posteriorly to mastoid process. 

\^ Mention the muscles attached to the outer surface of 
the malar bone. 

Levator labii superioris, zygomaticus major and minor. 

/ Describe the sigmoid notch. 

Situated between condyle and coronoid process of mandi- 
ble ; transmits masseteric vessels and nerves. 



7 



Mention the branches of the maxillary portion of the 
internal maxillary artery. 

Tympanic, middle meningeal, small meningeal and inferior 
dental. 

30 



466 ANATOMY. 

| Mention the branches of the posterior auricular artery. 

Stylomastoid, auricular, mastoid. 
•^ Give the branches of the internal maxillary artery. 

Prom the maxillary portion: tympanic, middle meningeal, 
small meningeal, inferior dental. From the pterygoid por- 
tion: deep temporal, buccal, pterygoid, masseteric. From 
the spheno-maxillary portion : alveolar, - infra-orbital, de- 
scending palatine, vidian, ptery go-palatine, spheno-palatine. 

^ Describe the Gasserian ganglion. 

Is developed upon the sensory root of the 5th cranial nerve, 
and is located in a depression on the petrous bone near its 
apex, cranial surface. From its anterior margin 3 divisions, 
the opthalmic, maxillary and mandibular pass through the 
sphenoidal fissure, the foramen rotundum and the foramen 
ovale, respectively. The motor root of this nerve rests upon 
the petrous bone beneath the sensory root, uniting with the 
mandibular division after it has passed through the fora- 
men ovale. 

Give the origin and insertion of the sternothyroid 
muscle. 

From the manubrium sterni and the cartilage of the 1st rib, 
into the oblique ridge of the thyroid cartilage. 

Describe the mylohyoid muscle, giving its origin and 
insertion. 

It forms, with the opposite mylo-hyoid, the floor of the 
mouth. Origin, is from the mylo-hyoid ridge of the mandible ; 
insertion, into the body of the hyoid bone, meeting its fellow 
in a median raphe. 

Nerve, mylo-hyoid, a branch of inferior dental ; action, to 
carry tongue upward and forward. 

Mention the orbital branches of the ophthalmic artery. 

Lachrymal, muscular, anterior and posterior ethmoidal, 
supra-orbital, frontal and nasal. 



ANATOMY. 467 

Describe the temporal fossa. 

Is bounded above by temporal ridge, below by pterygoid 
ridge on great wing of sphenoid and extends from external 
angular process of frontal to a point above mastoid bone. It 
is formed by parts of five bones : sphenoid, frontal, temporal, 
parietal and malar. It gives origin to the temporal muscle. 

Describe the great wing of the sphenoid bone. 

A large, strong process, extending from the side of the 
body of the sphenoid outward, forward, upward and back- 
ward, and continued behind into a sharp, pointed extremity, 
its spinous process, which contains the foramen spinosum, 
transmitting the middle meningeal artery. Its upper surface 
is concave for the temporal lobe of the cerebrum ; its external 
surface forms part of temporal and of zygomatic fossae, which 
are separated by the pterygoid ridge. The greater wing 
presents 2 important foramina, viz., foramen ovale and fora- 
men rotundum ; it forms the lower margin of the sphenoidal 
fissure and the upper boundary of the spheno-maxillary 
fissure. 

Give the course and distribution of the arteries and 
nerves which supply the upper alveolar arch. 

Arterial supply is derived from alveolar or posterior dental 
branch of internal maxillary, which sends branches into pos- 
terior dental canals to supply molar and bicuspid teeth and 
lining of antrum ; also from anterior dental branches of infra- 
orbital, which descend through anterior dental canals in wall 
of maxilla to be distributed to incisor and canine teeth. 

Nerve supply comes from posterior superior dental branches 
of superior maxillary division of the 5th cranial, which enter 
posterior dental canals, to be distributed to posterior teeth 
and to communicate with middle superior dental branch of, 
superior maxillary nerve which passes down through special 
canal in outer wall of antrum, and with anterior superior 
dental nerve, another branch of superior maxillary nerve 
which enters a canal in anterior wall of antrum, these 
branches supplying the teeth in their respective regions. 



468 ANATOMY. 

Describe the lesser wings of the sphenoid bone. 

They rise from the anterior superior surface of the 
sphenoidal body to which they are attached by 2 roots enclosing 
the optic foramen, which transmits the optic nerve and oph- 
thalmic artery. The superior surface is smooth and flat, 
broad internally and tapering to a point externally, and sup- 
ports part of the frontal lobe of the brain. The under sur- 
face forms the upper boundary of the sphenoidal fissure, and 
the posterior border is received by the fissure of Sylvius. 

Describe the palatine surface of the superior maxillary 
bone. 

Is formed by the palate process which projects horizontally 
inwai'd to articulate with palate process of the opposite bone, 
and with palate bone posteriorly. Its inferior surface is 
slightly concave and rough for muco-periosteal covering of' 
roof of mouth. AVhen both superior maxillary bones are arti- 
culated, a large orifice, the anterior palatine canal, is formed 
just behind the incisor teeth in the median line. On the un- 
der surface of the palate process may sometimes be seen 
the intermaxillary suture, extending from the anterior pala- 
tine foramen to between the lateral incisor and canine tooth. 
This indicates the line of union between the maxilla and the 
intermaxillary, (premaxillary, or incisive) bone. 

Describe the submaxillary triangle. 

Is bounded, above, by lower border of body of mandible and 
a line drawn from its angle to the mastoid process ; below by 
the posterior belly of the digastric; in front by the median 
line. Its floor is formed by mylo-hyoid and hyoglossus 
muscles. It contains the submaxillary gland, facial artery 
and vein, submental artery and mylo-hyoid artery and nerve; 
more posteriorly is the external carotid artery; more deeply 
are the internal carotid artery, internal jugular vein and 
the pneumogaxtrie nerve. 

Describe the middle cerebral artery. 

It is a branch of the internal carotid, given off at the an- 



ANATOMY. 469 

terior perforated space, and courses outward, upward aud 
backward in the fissure of Sylvius. Its bz-anches are : Antero- 
lateral ganglionic, (including the lenticulo-striate) inferior 
external frontal, ascending frontal, ascending parietal, 
parieto-temporal. 

■ Mention the facial branches of the facial artery. 

Muscular, inferior labial, superior and inferior coronary, 
lateral nasal and angular. 

Describe the lateral sinuses. 

Right and left lateral sinuses commence at internal occipi- 
tal protuberance, right being formed by superior longitudinal 
sinus, left by straight sinus; are located in attached margin 
of tentorium and groove of occipital, of parietal, of mastoid 
and then of occipital bone, again leaving cranial cavity through 
jugular foramen, just outside of which they unite with inferior 
petrosal sinus to form internal jugular vein. 

Mention the muscles attached to the superior maxil 
lary bone. 

Twelve : orbicularis palpebrarum, levator labii superioris 
alaeque nasi, inferior oblique, levator labii superioris, levator 
anguli oris, compressor naris, depressor alae nasi, dilatator 
naris posterior, orbicularis oris, buccinator, masseter and in- 
ternal pterygoid. 

^ Describe the supraorbital artery. 

Is a branch of ophthalmic artery, passes forward between 
levator palpebrae and periosteum of orbital roof to supra- 
orbital foramen, where it appeal's on external surface of 
frontal bone and divides into superficial and deep branches 
supplying integument, muscles and epicranial aponeurosis, 
anastomosing with temporal, frontal and opposite supra- 
orbital. 
J3> Mention the vessels and nerves that supply the sub= 
maxillary gland. 

Facial artery, facial vein ; nerves from submaxillary 



% 



470 ANATOMY. 

ganglion, which is formed by branches from chorda tympani. 
lingual and from sympathetic plexus around facial artery. 

Describe the Island of Reil. 

Also called central lobe, is deeply placed in Sylvian fissure, 
is of pyramidal shape and consists of 6 or 7 convolutions. 

State the formation and course of the inferior vena 
cava. 

Is formed on right side of 5th lumbar vertebra by union of 
the 2 common iliac veins. It rests upon bodies of lumbar 
vertebrae, lying to right of aorta, grooves posterior surface 
of liver, and passes through eaval opening in diaphragm to 
terminate in right auricle. 

State the origin, exit, distribution and functions of the 
pneumogastric nerve. 

Superficial origin from side of medulla in groove between 
olivary and restiform bodies ; exit through jugular foramen ; 
distributed to posterior part of auricle and external auditory 
meatus, motor nerve to pharynx, sensory and motor to larynx, 
helps to form superficial (left nerve) and deep cardiac 
plexuses, furnishes pulmonary, oesophageal and gastric 
branches. 

Describe the cavernous sinus. 

So named from being traversed by interlacing filaments. 
Is placed on side of body of sphenoid bone and extends from 
sphenoidal fissure to apex of petrous bone. It receives opthal- 
mic vein anteriorly, terminates in petrosal sinuses posteriorly, 
and communicates with opposite cavernous sinus through cir- 
cular sinus. The following structures pass through it: 3d, 
4th and ophthalmic division of 5th nerves, 6th nerve and in- 
ternal carotid artery. 
£' Describe the thyroid gland. 

It consists of right and left lobes connected by an isthmus 
across 2d, 3d and 4th tracheal rings: has a capsule and trabe- 
cule surrounding closed follicles, which contain colloid ma- 






ANATOMY. 471 

terial. Arterial supply comes from superior and inferior 
thyroid arteries ; thyroid veins drain it. It is intimately at- 
tached to trachea and alae of thyroid cartilage, and rises 
and falls with larynx. 

/ 

Bound the occipital triangle. 

In front, by sterno-mastoid muscle ; behind, by trapezius ; 
below, by posterior belly of omo-hyoid ; apex of triangle is at 
occiput. 

Describe the outer surface of the occipital bone. 

Is convex, smooth above, rough below. Superior Curved 
line extends transversely, with external occipital protuber- 
ance at center; from latter, external occipital crest passes 
downward to posterior margin of foramen magnum, and meets 
inferior curved line half way down. Antero-lateral mar- 
gins of foramen magnum are bounded on either side by occi- 
pital condyles, in front of which is anterior condyloid foramen, 
and behind which is posterior condyloid foramen. Under 
surface of basilar process is rough for muscles, and presents 
pharyngeal spine at its center. Margins are roughly serrated, 
jugular processes extend laterally. 

From how many centers of ossification is the temporal 
bone developed? 
Ten. 
What is an aponeurosis? 

It is a more or less broad, flat sheet of fibrous tissue to 
which muscular fibers are attached, serving as a tendon of 
insertion for these fibers. 

Describe the horizontal plate of the palate bone. 

Is quadrilateral and presents two surfaces and four bor- 
ders. Superior surface is smooth and slightly concave from 
side to side, forming posterior floor of nose ; inferior surface 
is rough, forms posterior part of roof of mouth, and at outer 
posterior angle is deeply grooved to help form posterior 



472 ANATOMY. 

palatine canal. Anterior border is serrated to articulate with 
palate process of superior maxillary bone ; posterior border 
is smooth, concave, and gives attachment to soft palate; in- 
ternal border is thick and serrated for articulation with op- 
posite horizontal plate; external border joins perpendicular 
part of palate bone. 

What are the bones of Bertin? 

The sphenoidal turbinate, two in number, hollow, pyra- 
midal, attached to anterior surface of body of sphenoid, near- 
rostrum; they form the roof of each nasal cavity and a 
small part of the inner wall of the spheno-maxillary fossa. 

Define veins, arteries, lymphatics. 

Veins are tubular parts of the blood-vascular system carry- 
ing venous blood from all parts of the body toward the right 
auricle, or arterial blood from the lungs toward the left 
auricle ; their walls are thin and their tunica intima forms 
reduplications, or valves, in some veins. 

Arteries are vessels carrying blood away from the heart, — 
arterial in all cases except in the pulmonary artery, where 
the blood is venous, en route to the lungs; the wall of the 
artery is relatively thick. 

Lymphatics are vessels which convey lymph from all parts 
of body to venous circulation at base of neck, on each side; 
lymphatics of mesentery are called lacteals. 

Describe the ophthalmic vein. 

There are 2 ophthalmic veins, superior and inferior. Su- 
perior ophthalmic vein connects angular vein at inner angle 
of orbit with cavernous sinus; it takes the same course as 
the ophthalmic artery, receiving tributaries from upper or- 
bital contents. The inferior ophthalmic vein drains the floor 
of the orbit, passing through spheno-maxillary fissure to end 
in pterygoid plexus of veins, or through sphenoidal fissure 
to terminate in cavernous sinus. 



ANATOMY. 473 

Mention the branches of the inferior thyroid artery. 

Inferior largyngeal, tracheal, esophageal, ascending cervi- 
cal, muscular. 

Give the articulations of the ethmoid bone. 

With 15 : sphenoid, 2 sphenoidal turbinated, frontal, 2 
superior maxillary, 2 lachrymal, 2 nasal, 2 palate, 2 inferior 
turbinated, and vomer. 

Describe the medulla oblongata. 

Is a part of encephalon, continuous with spinal cord be- 
• low and with pons above; it rests upon the basilar process of 
occipital bone, consists of white nerve matter externally and 
gray matter arranged irregularly, internally, the latter ap- 
pearing upon the surface in floor of 4th ventricle, the lower 
half of which is formed by medulla; upon ventral surface 
is anterior median fissure, partially obliterated below by de- 
cussation of crossed pyrmidal tracts ; near anterior part 
of inferior surface are olivary bodies ; posterior columns di- 
verge to form calamus scriptorius and to bound 4th ven- 
tricle laterally for its lower half; postero-laterally are resti- 
form bodies which can be traced upward into cerebellum, 
forming inferior peduncles of latter. Cranial nerves from 
7th to 11th inclusive arise from side of medulla, while 12th 
appears upon surface in groove between olivary body and 
anterior pyramid. 



4- 



Give the articulations of the lachrymal bones. 

With 4 bones : frontal, ethmoid, superior maxillary and in- 
ferior turbinated. 



/ — - Mention the muscles and ligaments attached to the 
ramus of the jaw. 

Masseter, temporal, external and internal pterygoids ; liga- 
ments are capsular (external lateral), internal lateral 
(spheno-mandibular), and stylo-mandibular. 



474 ANATOMY. 

Mention the vessels and nerves supplying the parotid 
gland. 

Arteries are derived from external carotid ; veins, tribu- 
taries to external jugular; lymphatics terminate in super- 
ficial and deep cervical nodes ; nerves are derived from facial, 
auriculotemporal, great auricular, and sympathetic plexus 
on external carotid artery. 

Describe the 9th (glossopharyngeal) nerve. 

Arises from groove between olivary and restiform bodies, 
passes out of cranial cavity through jugular foramen, divides 
into lingual and pharyngeal branches, supplying mucous 
membrane of posterior part of tongue (circumvallate papillae) 
and mucous membrane of pharynx. A branch (Jaeobson's) 
is distributed to tympanum. 

X Describe briefly the 5th nerve. 

Superficial origin of both motor and sensory roots is from 
pons near anterior margin; Gasserian ganglion develops on 
sensory root and rests on apex of petrous bone, now forming 
3 divisions, ophthalmic, maxillary and mandibular; ophthalmic 
division divides into frontal, nasal and lachrymal branches 
which leave cranial cavity by sphenoidal fissure ; maxillary 
division leaves cranial cavity by foramen rotundum, crosses 
spheno-maxillary fossa, enters orbit, terminating as infra- 
orbital nerve; mandibular division and motor root leave cran- 
ial cavity by foramen ovale, unite and then divide to supply 
muscles of mastication with motor influence, and anterior 
part of auricle, lower jaw and part of tongue with sensory 
influence. 

Give a general description of the alimentary canal, nam= 
ing its successive divisions. 

Its parts, in order, are: mouth, pharynx, esophagus, 
stomach, duodenum, jejunoileum, and large intestine (caecum, 
ascending, transverse, descending and sigmoid colons, rectum. 
and anal canal) . 



ANATOMY. 475 

Mouth is composed of upper and lower jaws covered by 
cheek walls, with buccal orifice directed transversely; con- 
tains tongue, at base of wihch are fauces with anterior 
and posterior pillars and tonsils. 

Pharynx joins esophagus at lower border of cricoid carti- 
lage; esophagus is 10 inches long and passes through dia- 
phragm to be continued into stomach. 

Stomach occupies epigastric and left hypochondriac re- 
gions and presents a cardiac and a pyloric extremity and a 
greater and a lesser curvature. Its wall consists of 4 coats, 
viz., serous, muscular, areolar and mucous. 

Duodenum is fixed and curved around head of pancreas; 
common bile and pancreatic ducts open into it; jejuno-ileum, 
attached to posterior abdominal wall by mesentery, extends for 
20 feet, or more, to ileo-caecal junction, where it joins 
large intestine ; vermiform appendix is attached to caecum 
(usually inner side), below ileo-caecal valve; ascending colon 
passes to liver, forms hepatic flexure; transverse colon, with 
great omentum attached, crosses to spleen and forms splenic 
flexure; descending colon reaches left iliac fossa and is con- 
tinued into sigmoid which curves around into pelvis, resting 
on sacrum ; rectum curves forward and anal canal, guarded 
by internal (involuntary) and external (voluntary) sphinc- 
ters, opens downward and slightly backward. 

Give the origin, course and distribution of the great 
sciatic nerve. 

Origin from lower lumbar and upper sacral nerves (sacral 
plexus) ; course, through great sacro-sciatic foramen below 
pyriformis muscle, from beneath lower margin of gluteus 
maximus midway between trochanter major and tuber ischii, 
rests upon adductor magnus and divides about middle of 
thigh into internal and external popliteal nerves ; it supplies 
semitendinosus, semimembranosus, adductor magnus and 
biceps. Internal popliteal is continued down leg as posterior 
tibial, distributed to back of leg and sole of foot; external 



476 ANATOMY. 

popliteal curves around below head of fibula to front of leg, 
becoming anterior tibial to front of leg and dorsum of foot. 

Describe the anatomical position of the thoracic duct, 
(b) Where does it terminate? (c) What does it convey? 

Thoracic duct begins in receptaculum chyli on body of 
2d lumbar vertebra, to right of aorta, passes through aortic 
opening of diaphragm into posterior mediastinum, (b) It 
terminates at junction of left internal jugular and left sub- 
clavian veins, (c) It conveys lymph and chyle. 

Give the origin, insertion and nerve supply of the stylo- 
glossus muscle. 

Origin, from styloid process of temporal bone; insertion 
into side of tongue; nerve, hypoglossal. 

Bound the superior carotid triangle. 

Behind, by sterno-mastoid ; below, by anterior belly of omo- 
hyoid ; above, by posterior belly of digastric. 



INDEX. 



Abrasion of the teeth, 7, 210 
Abscess, 138, 181, 185, 191 

Alveolar, 28, 123, 173, 

212 
Apical alveolar, 200 
Blind, 28 

Chronic alveolar, 164 
Pericemental, 27, 127 
of temporary teeth, 210 
Abscessed deciduous tooth, 33 
Absorption, 271 

of food, 395 
Accidents in extracting teeth, 31 
Acids, 279 

Aconite, 221, 224, 230, 259 
Acquired cleft palate, 117, 154 
Acute arthritis, 174 
periostitis, 170 
ranula, 107 
Adhesion, 267 
Adipose tissue, 348 
Aerobic bacteria, 197 
Afferent nerves, 401 
Alcohol, 306, 396, 400, 427 
Alimentary canal, 474 
Alkali, 284 

Alkalies in dentistry, 227 
Alkaline, 264 
Alkaloids, 284, 305, 307 
Alloys, 313 
Alteratives, 253 
Aluminum, 329 

in dentistry, 61 
solder, 61 
Alveolar abscess, 123, 164, 173, 209 
arch, 467 
dental abscess, 28 
process, 61, 391 

Cysts of, 198 
Necrosis of, 169 
Amalgam, 309, 315, 328 

and cement filling, 17 
copper, 326 
fillings, 9 



Amalgamation process, 323 
Ameloblasts, 352, 373 
209, Amianth, 330 
Ammonia, 296 
Amputation of the root, 28 
Amyl nitrite, 224, 253 
Amyloid foods, 389 
Anaerobic bacteria, 197 
Analgesic, 246 
Analysis, 279, 283, 302 
Analytical chemistry, 288 
Anatomy, 441 

morbid, 200 
Anchorage for gold fillings, 13 
Anemia, 196 
Anesthesia, 103, 132 
Anesthetics, 246 

General, 145, 224 
Local, 137, 233, 256 
Aneurysm, 185 
Angle'method, 89, 177 
Anhydride, 264 
Anhydrous, 264 
Animal life, 288 
Ankylosis, 126 

False, 144 
Annealing, 311 
Anode, 271 

Anterior cervical triangle, 465 
Antidote, chemical, 240 
Antimony, Test for, 317 
Antiphlogistic, 229 
Antipyretics, 251 
Antisepsis, 192 
Antiseptics, 215, 225 
Antitoxin, 193 
Antral disease, 118 
Antrum, Empyema of, 134, 157, 

162, 231 
Antrum, Tumors of, 133 
Aorta, 459 
Aphthae, 122 
Aphthous stomatitis, 122 
Apical alveolar abscess, 200 

(477) 



478 



INDEX. 



Aponeurosis, 471 

Approximal cavities, 4 

Aqua regia, 298 

Aqueous solutions, 229 

Arrested development of maxillae, 

177 
Arsenic, 23, 156, 217, 222, 259, 260, 
316 

necrosis, 127 
Arsenious acid, 228, 229 
Arterial hemorrhage, 104 
Arteries, 368, 391, 404, 472 

Wounds of, 146 
Arthritis, 143 

Acute, 174 
Articular cartilage, 370 
Articulation, Temporo-maxillary, 117 
Artificial crowns, 19, 74 

respiration, 155 

direct method, 
129 

teeth, 46, 49, 55 

velum, 92 
Asbestos, 330 
Asepsis, 184, 192 
Aseptic wounds, 148, 174 
Asepticism of cavities, 8 
Asphyxia, 145 

Mechanical, 115 
Assay, 302 
Assimilation, 394 
Astringents, 252 
Atmospheric air, 299, 433, 435 
Atom, 283 

Atomic weight, 284, 285 
Atrophy, 191 
Atropine poisoning, 242 
Avogadro 's law, 277 
Axis cylinder, 364 

process, 364 

Babbitt metal, 60 
Bacilli, 196 

Bacteria, 183, 188, 192, 193, 195, 
213, 215 

Diseases due to, 193 

Parasitic, 208 

Pathogenic, 187, 193, 202 

Saprophytic, 218 
Bacterial cell, 186 
Bandage, Barten 's, 140 
Bandage, Four-tailed, 141 
Bandage, Gibson 's, 146 
Banded Logan Crown, 74 



Barton 's bandage, 140 
Base, celluloid, 58 

metal, 312 
Base plate, 45 

vulcanite, 53 
Bathing, 394, 423 
Belladonna, 241 
Benign tumors, 166, 187, 190 
Bertin 's bones, 472 
Bicuspid crown, 77 

jacket crown, 77 
Bile, 387 
Bioplasm, 369 

Blackening of gold fillings, 15 
Blastoderm, 366 
Bleaching, 299 

of the teeth, 26 
Blind abscess, 28 
Blood, 365, 388, 397 

-plasma, 413 

-platelets, 341 
Blowpipe, Knapp, 96 
Blue vitriol, 300 
Body-temperature, 380, 385 
Bone, 302, 359, 372, 392 
Bonwill articulator, 94 

crown, 76 
Bony consolidation after fracture, 

101 
Bridges, 19 
Bridge, Removable, 85 

-work, 83 
Bromine, 293 
Brophy 's operation, 159 
Brown 's porcelain bridge, 87 
Buccal cavity, carcinoma of, 189 
Buccinator, 445 
Buttner crown, 82 
Bunsen burner, 267 
Burs, 3 

Cachexia, 195 
Calcification, 376 

of teeth, 365 
Calculus, Salivary, 37, 145, 149, 173, 
201, 215 
Sanguinary, 37, 203 
Serumal, 203 
Callus, Definitive, 190 

Intermediate, 190 
Provisional, 189 
Calomel, 312 
Canal, Pulp, 24 
Root, 24 



INDEX. 



479 



Canaliculi, 372 
Cancrum oris, 123 
Oandle flame, 266 
Cap, Gold, 79 
Capillaries, 377, 391, 404 
Capillary attraction, 271 
Capping of pulp, 22, 208 
Capsicum, 231 
Carat, 319 
Carbolic acid, 133, 223, 255 

poisoning, 239 
Carbon, 294 

dioxide, 294 
Carcinoma, 184, 188, 193 

of buccal cavity, 164 
tongue, 102, 167 
Carcinomatous ulcer, 202 
Care of teeth in children, 35 
Caries, 39, 151, 218 

Dental, 1, 209, 213 
fungosa, 171 
necrotica, 172 
of maxillae, 171 
sicca, 171 
suppurativa, 171 
Cartilage, 347, 351, 376 
Case 's appliance, 90 

retainer, 90 
Casein, 401 
Cast-iron, 324 
Cataphoresis, 240, 248 
Cataphoric applications, 225 
Catarrhal inflammation, 189 
Cathartics, 236, 251 

saline, 240, 258 
Cathode, 271 
Causes of disease, 197 
Cavernous sinus, 470 
Cavities, Approximal, 4 
Aseptieism of, 8 
Cervical, 5 
Excavation of, 3 
Formation of, 2 
Preparation of, 2 
Protection of, 5 
Cavity-margins, 3 
Cell, 359 

Bacterial, 186 
Cellulitis, 175 

Suppurative, 106 
Celluloid, 175 

base, 58 
Cement, 9, 94 
Cementoblasts, 371 



Cementum, 357 

Centers of ossification, 350 

Cerebellum, 442 

Cerebrospinal axis, 384 

Cerebrum, 389 

Cervical cavities, 5 

Chemical affinity, 287 

antidote, 240 

composition of muscle, 412 

compound, 282, 286 

equation, 280 

reaction, 280 
Chemistry, 263 
Cheoplastic process, 59 
Chlorine, 292 

Chloroform, 229, 237, 241, 245, 260, 
305 
Syncope under, 168 
Chromogenic bacteria, 196 
Chronic alveolar abscess, 164 

inflammation, 156 
Cilia, 343 
Cinnabar, 333 
Circle of Willis, 461 
Circuit, 271 

Circulation of the blood, 381 
Circulatory apparatus, 404 
Clasp gold, 69 
Cleansing the teeth, 39 
Cleaveland vacuum-cavity, 48 
Cleft palate, 91, 117, 153, 159, 190 
Acquired, 154 
Operation in, 101 
Cocaine, 234, 235, 253, 256 

poisoning, 239 
Cocci, 196, 197 
Cohesion, 267 
Cohesive gold, 12 
Cold bath, 422 

inflammation, 101 
Collapse, 239, 261 
Color of teeth, 26 
Columnar epithelium, 346 
Columns of the spinal cord, 413 
Combination fillings, 15 
Combined gold fillings, 14 
Combustion, 289 
Compact bone, 364 
Compound, 281, 286 

• fracture of inferior max- 
illa, 121, 169 
molecule, 285 
Conductors of electricity, 269 
Congenital dislocation, 146 



480 



INDEX. 



Congested pulp, 20 

Connective tissue, 343, 346, 357, 

362, 377, 441 
Contamination of drinking-water, 417 
Continuous gum-denture, 70 
Contused wounds, 102 
Copper, 313 

amalgam, 326 
sulphate, 257, 301 
Cores, 60 

Corrosive sublimate, 327 
Cottonoid, 5 
Counter-die, 59 

-irritants, 221 
Countersunk-pin Teeth, 50 
Cremation, 425 
Creasote, 230, 255 
Crib, Jackson, 89 
Crooked buccal root-canals, 25 
Crown, Artificial, 19, 83 

Bicuspid, 77 

Bicuspid jacket, 77 

Bonwill, 76 

Buttner, 82 

Davis, 80 

Logan, 74 

Mason, 78 

Pin, 87 

Richmond, 75 

Shell, 78 
Crude rubber, 51 
Culture medium, 196, 203 
Cylindric epithelium, 142 
Cyon and Ludwig 's nerve, 383 
Cystic dilatation of Steno 's duct, 113 
Cysts, 138, 148 

of the alveolar process, 198 

Dental, 198 
Dentigerous, 109, 121, 198 

Multiloeular, 154, 198 

of the tongue, 107 

Dark joints in gum teeth, 51 

Davis crown, 80 

Dead pulp, 24 

Decay in deciduous teeth, 32 

under plate clasps, 6 

White, 4 
Deciduous teeth, 41, 219 
Decoctions, 248 
Decomposition, 186 
Deep-seated dental caries, 1 
Definitive callus, 190 
Deglutition, 385 



Deliquescence, 263 
Dental calcification, 371 
Dental caries, 1, 209 
cysts, 198 
exostosis, 210 
fibrillae, 375 
follicle, 374 
neuralgia, 20 
orthopedia, 35 
papilla, 372 
pulp, 400 
ridge, 366 
shock, 6 
tubuli, 356 
Dentifrices, 229, 247 
Dentigerous cysts, 109, 121, 198 
Dentine, 307, 374 

Highly inflamed, 6 
Hypersensitive, 216 
Secondary, 7 
Dentistry, Operative, 1 

Prosthetic, 43 
Dentition, Pathological, 208 
Deodorants, 251 
Deposits on teeth, 37 
Dermoid cysts, 148 
Destructive distillation, 269 
Devitalization of pulp, 23 

of teeth, 210 
Diad, 278, 286 
Diagnosis, 200 
Diamond, 295 
Diaphoretics, 237,239 
Diathesis, 195 
Diatoric teeth, 48 
Die, 59 

Diffusible stimulants, 258 
Diffusion. 271 
Digastric muscle, 458 
Digestion, 379 
Digitalis, 226, 243 
Diphtheria, 427, 431 

-infection, 415 
Direct method of artificial respira- 
tion, 129 
Disease, Causes df, 197 

of dental pulp, 208 
I diseases due to bacteria, 193 
of maxillae, 188 
of pericementum, 216 
Disinfectants, 222, 225, 415 
Disinfecting lotions, 163 
Disinfection, 194, 416, 418 
of hands, 136 



INDEX, 



481 



Dislocations, 115, 146, 151 

Traumatic, 128 
Displacement, 137 
Diuretics, 239 
Double fracture of inferior maxilla, 

159 
Dowel, 87 
Drinking-water, Contamination of, 

417 
Dry-earth system, 418 
Ductility, 2*64 

Eburnation, 8 
Efferent nerves, 401 
Effervescence, 264 
Efflorescence, 263 
Elbow- joint, 453 
Elastic tissue, 363 

fibrous tissue, 343 
Electric current, 266, 271 
Elasticity, 264, 269 
Electricity in dentistry, 39 
Electrolysis, 284 
Electro-magnet, 270 
Electro-motive force, 271 
Electroplating, 266 
Element, 279, 281 
Embolism, 187 
Embolus, 185 
Embryology, 367 
Emetics, 239, 251 
Empyema of the antrum, 134, 157, 

162 
of maxillary sinus, 191 
Enamel, 307, 327, 357, 373 

organ, 375 
Enchondronal bone, 363 
Endemic diseases, 436 
Endocardium, 349 
Endoneurium, 341 
Endosmosis, 405 
Endothelium, 376 
Energy, 269 
English Tube teeth, 65 
Epidemic diseases, 436 
Epiglottis, 391 
Epineurium, 341 
Epistaxis, 131 
Epithelioma, 142 

of the lips, 136 
Epithelium, 360, 368, 369, 376 
Epulic tumors, 121 
Epulis, 121, 190, 211 
Ergot, 242 

31 



Erosion, 139 

of teeth, 7,218 
Eruption of teeth, 216, 406 
Erythrocytes, 365 
Escharotics, 224, 229 
Essential oils, 223 
Ether, 235, 244, 246, 260 
Ethmoid bone, 445 
Ethyl bromide, 235, 249 

chloride, 232 
Ethylic alcohol, 306 
Etiology, 200 
Eucaine, 234, 256 
Examination of teeth, 38 
Excavation of cavity, 3 
Excavator points, 3 
Exhumations, 423 
Exosmosis, 405 
Exostosis, 30, 203, 210 

Dental, 212 
Expansion of the upper arch, 36 
Expectorants, 239 
Exposed pulp, 20, 33 
External fistula, 119 

jugular vein, 446 

of teeth, 30 

of deciduous teeth, 32 

of molar teeth, 111 

Facial artery, Ligation of, 102 
nerve, 125, 450 
vein, 463 
Facultative bacteria, 197 
False ankylosis, 144 
Farrar 's System, 88 
Fatty tumor, 138 
Feeble pulse, 165 
Fermentation, 200, 304 

Lactic, 214 
Fibrin, 342 
Fibro-cartilage, 346 
Fibrous epulis, 190 
Fifth nerve, 474 
Filling, Amalgam, 9 

and cement, 17 
Cohesive gold, 12 

and non-cohesive 
gold, 14 
Combination, 15 
of deciduous teeth, 33 
gold, 2,11, 41 

and amalgam, 16 
and cement, 16 
and tin, 16 



482 



INDEX. 



Filling, Gutta-percha, 9 

and zinc phos- 
phate, 15 
-materials, 8 
Metallic, 338 
Non-cohesive gold, 13 
Plastic, 10 
Porcelain, 18 
of pulp-canals, 24 
Tin, 11 
Fistula, 140 

External, 119 
Salivary, 149,174 
Fixed oils, 248 
Fluid extracts, 249 
Fluorine, 292 
Flux, 64, 314 
Food, 401, 419, 430 
Force, 269 

Foreign body in the nose, 162 
Formaldehyde, 228, 249 

-disinfection, 416 
Formation of Cavities, 2 
Formula, 285 
Four-tailed bandage, 141 
Fracture, 113, 126 

of mandibular condyle, 158 
of inferior maxilla, 93, 

102, 108, 135 
of superior maxilla, 135, 
177 
Fractures, Repair of, 198 
Frequent pulse, 169 
Frontal bone, 447 
Function, 396 
Fungi in mouth, 214 
Fungoid pulp, 25, 211 
Furbinger 'a method, 136 

Galvanic cells, 265 
Ganglion, 358, 412 
Gangrene, 104 

Gangrenous stomatitis, 123, 198 
Gasserian ganglion, 466 
Gastric juice, 386, 392 
Gastrocnemius, 443 
Gelatine plates, 187 
General anesthetics, 224 

pathology, 197 
Genio-hyoglossus muscle, 456 
Germicides, 215, 251 
Germs, 193 

Germ-theory of disease, 430 
Giant cells, 350 



Gibson 's bandage, 146 
Gingivitis, Marginal, 129 

Syphilitic interstitial, 129 
Glacial phosphoric acid. 303 
Glenoid fossa, 464 
Glossopharyngeal nerve. 474 
Glottis, Obstruction of. 161 
Glycogen, 408 
Gold, 317 

and amalgam filling, 16 

bridge, 83 

cap, 79 

and cement filling, 16 

clasps, 69 

Cohesive, 12 

fillings, 2, 11 

Anchorage for, 13 

inlays, 19 

Non-cohesive, 12 

plate, 63, 64, 67, 68 

Refining of, 318 

and silver plates, 62 

Test for, 317 

and tin filling, 16 
Goniometer, 98 
Grain alcohol, 306 
( rraphite, 295 
Gravitation, 267 
Green stain, 33 
Grenet cell. 265 
(iriswold retainer, 99 
Grove cell, 205 
Gum-boil, 173 
Gumma of mouth, 141 
of tongue, 167 
Gums, Hemorrhage from the, 150 

Hypertrophy of, 119 
Papilloma of, 133 

Spongy, 127 

Tumors of, 183 
Gustatory nerve, 401, 461 
Gutta-percha, 9 

and zinc phosphate 
fillings, 15, 94 
Gypsum, 301 

Haemo-; see Hemo- 
Hammond wire splint, 113 
Hands, Disinfection of, 136 
Hand pressure, 17 
Hard pulse, 163 
water, 426 
Hardening of tissues, 342 
Hare-lip, 125, 157 



INDEX. 



A8A 



Haversian canals, 372 
system, 360 
Hawes molding-flask, 60 
Healing of wounds, 156, 194 
Heart, 348, 392, 394 

Mechanism of, 383 
Valves of, 396 
Heat, 146, 380 

in inflammation, 175 
Heating of houses, 429 
Hemoglobin, 358 
Hemorrhage, 115, 126, 133, 196 
Arterial, 104 
from the gums, 150 
from inferior dental 

canal, 164 
after lancing of gums, 

118 
after tooth-extraction, 

32, 118 
Secondary, 105, 176 
from tongue, 144 
Hemostatics, 225 
Highly inflamed dentin, 6 
Highmore 's antrum, 455, 461 
Histology, 341, 359 
House-plumbing, 416 
Hutchinson 's teeth, 211 
Hydrate, 264 

Hydrochloric acid, 237, 275 
Hvdrogen, 289 

dioxide, 248, 292 
peroxide, 224 
Hydrometer, 263 
Hygiene, 415 
Hyoid bone, 445 
Hyperemia, 196, 214, 217 

of the pulp, 130 
Hypersensitive dentine, 5, 216 
Hypertrophy, 193 

of the gums, 119 
Hypnotics, 250 
Hypoblast, 349 
Hypoglossal nerve, 389, 405, 450 

Idiosyncrasy, 221 
Immunity, 437 
Impacted wisdom tooth, 135 
Impaction of molar, 200 
Implanting, 29 
Implantation of teeth, 112 
Impressions, 43, 44, 45 
Impression of cleft palate, 91 
Incised wound, 151 



Incisor, Approximal cavity of, 5 
Incompatibility of drugs, 241 
Inductive force, 271 
Infectious osteomyelitis of inferior 

maxilla, 169 
Inferior dental artery, 461 
maxilla, 444, 457 

Compound fracture 

of, 121, 169 
Fracture of, 93, 

102, 108, 135 
Infectious osteomy- 
elitis of, 169 
Inferior maxilla, Luxation of, 120 
Necrosis of, 169 
Osteoma of, 106 
Periostitis of, 131 
Ununited fracture 
of, 143 
maxillary nerve, 459 
vena cava, 470 
Inflamed periosteum, 26 
Inflammation, 116, 184, 185, 201, 
207, 214 
Catarrhal, 189 
Causes of, 199 
Chronic, 156 
Cold in, 101 
Heat in, 175 
of mouth membranes, 1 
Pain in, 189 
Suppurative, 163, 189 
Swelling in, 176 
Infusions, 248 
Inlays, Gold, 19 

Porcelain, 18, 40 
Inorganic chemistry, 289 

compounds, 286 
Inspiration, 408 
Interglobular spaces, 374 
Intermediate callus, 190 
Intermittent pulse, 163 
Internal jugular vein, 460 

maxillary vein, 463 
Interpolation, 137 
Intestinal digestion, 40S 
Intramembranous bone, 363 
Investments, 86 
Involuntary muscles, 389 
Iodine, 223, 228, 293 
Iodism, 238 
Iodoform, 225, 249 
Iron, 222 
Irregular pulse, 165 



484 



INDEX. 



Irregularity of the Teeth, 35, 37, 174 
Irritable pulp, 211 
Irritants, 227, 231 
Irritation of the pulp, 21 
Island of Reil, 470 

Jackson crib, 89 

Kelly 's method, 137 
Kidneys, 379 
Knapp blow-pipe, 96 
Knee-joint, 453 

Labial bow, 97 
Laborde 's method, 155 
Lacerated wounds. 102, 143 
Lactic acid, 304 

fermentation, 214 
Lacunae, 348 
Lampblack, 295 
Lancing, 124 

of the gums, 32 

Hemorrhage 
after, 118 
Latent heat, 271 
Lateral sinuses, 469 
Laughing gas, 28, 234, 245, 259, 260 
Law of multiple proportions, 287 
Lead, 312, 329 
Leucocytes, 213, 355, 366 
Leukomains, 183 
Ligation of arteries, 130, 134 
of facial artery, 102 
of temporal artery, 103 
Lingual artery, 462 

carcinoma, 102 
nerve, 461 
Lip, Epithelioma of, 136 
Liquid nitrous oxide, 234 
Liver, 387, 395 
Local anesthesia, 137, 233 
anesthetics, 222, 256 
hyperemia, 196 
treatment of hemorrhage, 133 
Logan crown, 74 
Lunar caustic, 323 
Luxation of inferior maxilla, 120 
Lymphatic system, 384, 403 
Lymphatics.'358, 367 

Microglossia, 157 
Magill band, 97 
Magnets, 270 
Malignant tumors. 166, 187 



Malleability, 264 
Mallet pressure, 17 
Mandible, 444 
Marginal gingivitis, 129 

zone, 343 
Margins, cavity, 3 
Marrow, 344 
Mason crown, 78 
Mastication, 409 

muscles of, 458 
Mastoid bone, 448 
Materia medica, 221, 238 
Matrix, 17 
Matter, 269, 282 
Matteson lingual bow, 97 
Maxilla, fracture of, 177 
Maxillae, arrested development of, 
177 
caries of, 171 
diseases of, 188 
Maxillary sinus, 455, 461 

empyema of, 191 
suppuration of, 112 
tumor of, 112 
Mechanical asphyxia, 115 
Mechanism of the heart, 383 
Meckel 's cartilage, 374 
Medulla oblongata, 382, 473 
Medullary substance, 364 
Mercurial stomatitis, 141, 214 
Mercuric chlorid, 208, 327 
Mercury, 325, 327 
Mesoblast, 365, 372 
Metabolism, 411 
Metallic compound, 309 

elements, 279, 309 
Metallurgy, 263, 307 
Metals, 307 
Method, Angle, 89 

of swaging, 62 
Methylic alcohol, 306 
Micro-organisms, 192 

of pus, 186 
Middle cerebral artery, 468 
Milk, 402 

adulteration, 424 
sterilization, 426 
Miller 's theory, 213 
Mixed diet, 437 
Mixture, 282 

Moist gangrene of the pulp, 128 
Molar, impaction of, 200 

teeth, extraction of. Ill 
Molecular weight. 280 



INDEX. 



485 



Molecule, 283 
Monad, 278, 286 
Morbid anatomy, 200 
Morphia, 259 
Mouth, gumma of, 141 

membranes, inflammation of, 
1 

syphilis of, 138 

tumors of, 143 
Mucous membranes, 370 

tissue, 363 
Multilocular cyst, 154, 198 
Mummification of dental pulp, 25 
Muriatic acid, 293 

Muscle, chemical composition of, 412 
Muscles of mastication, 458 

the tongue, 462 
Muscular tissue, 367 
Mydriatics, 236 
Myeloid sarcoma, 135 
Mylohyoid muscle, 466 

nerve, 457 
Myocardium, 348 
Myxomatous tissue, 347 

Naphthol, 230 
Narcotics, 229, 250 
Nasal bones, 450 
Nasmyth 's membrane, 347 
Nausea in prosthetic dentistry, 45 
Necrosis, 150, 205, 211 
Arsenic, 127 
of alveolar process, 161 
inferior maxilla, 169 
the jaw, 104 
Phosphorus, 428 
Negative elements, 282 

metallic fillings, 329 
Nerve cells, 361 
Facial, 125 
fibers, 341, 348, 358 
Nerves of special sense, 411 
Nervous system, 402, 441 
Neuman 's sheath, 375 
Neuralgia, 136, 204 
Dental, 20 
Trifacial, 115, 172 
Neurasthenia, 108 
Neurilemma, 364 
Neuritis, 136, 144 
Neuro-epithelium, 364 
Neuroglia, 341 
Neutral, 264 
Nitric acid, 236 



Nitrogen, 296, 297 

Nitrous oxide gas, 233, 234, 245, 

259, 260 
Noble metal, 312 
Non-cohesive gold, 12 

-conductors of electricity, 269 

-metallic elements, 279 

-virulent germ, 193 
Normal pulse, 393 
Norton-Talbot spring, 96 
Nose, Foreign body in, 162 
Nuclear matrix, 357 
Nucleus, 356 
Nuisance, 423 
Nutrition, 398 
Nux-vomica, 243 

Obstruction of the glottis, 161 
Obturator, 91, 92 
Occipital appliance, 97 
bone, 471 
triangle, 471 
Occipito-frontalis, 463 
Occlusion of teeth, 56 
Odontalgia, 20, 155 
Odontoblasts, 356, 361 
Odontoma, 109 
Oil of cinnamon, 231 

cloves, 230 
Omohyoid muscle, 456 
Operation in cleft palate, 101 
Operations on syphilitics, 114 
Operative dentistry, 1 
Ophthalmic artery, 449 
nerve, 452 
vein, 472 
Opium, 223, 243, 257 
Oral mucous membrane, 344 

pathology, 188 

surgery, 101 
Organic chemistry, 289 
compounds, 286 
tissue, 358 
Orthodontia, 105 
Orthophosphoric acid, 303 
Osmose, 271 
Os planum, 457 
Osteoblasts, 344, 363 
Osteoclasts, 363, 371 
Osteoma of inferior maxilla, 106 
Otic ganglion, 450 
Overstrain, 426 
Oxalic acid, 304 
Oxidizing agent, 277 



486 



INDEX. 



Oxygen, 290, 283 
Oxygenation of the blood, 381 
Ozaena, 134 
Ozone, 291 

Pain in inflammation, 189 
Painful pulp, 21 
Palate bone, 471 
Palatoglossus muscle, 460 
Pancreas, 383 
Pancreatic juice, 388 
Papillae of the tongue, 373 
Papilloma of the gums, 133 
Parablast, 341 
Parasites, 184 
Parasitic bacteria, 208 

stomatitis, 122 
Parotid gland, 399, 447 

secretion, 399 
Passive hyperemia, 196 
Pasteurization, 186 
Patch, Smoker 's, 166 
Pathogenic bacteria, 187, 193, 202 

fungi in mouth, 214 
Pathological dentition. 208 
Pathology, 183, 197 

of pulp, 22 
Pavement epithelium, 343 
Perforated hard palate, 91 
Pericardium, 348 
Pericemental abscess, 27, 127 
membrane, 370 
Pericementitis, 27, 2-12 

Phagedenic, 210 
Septic, 209 
Pericementum, Disease of, 216 
Perichondrium, 376 
Peridental membrane, 354, 359 
Perineurium, 341 
Periodontitis, 210 
Periosteum, 360 

Inflamed, 26 
Periostitis, 189 

Acute, 1 To 

of inferior maxilla, 131 

Suppurative. 152 

Syphilitic, 172 
Permanent magnet, 270 
Perspiration, 394, 410, 412 
Petrous bone, 448 
Peyer 's patches, 343 
Phagocyte, 366 

Phagedenic pericementitis, 210 
Phleboliths, 203 



Phosphoric acid, 275, 3<i2 
Phosphorus-necrosis, 428 
Physics, 263 
Physiology, 379 
Pin crown, 87 
Pinless teeth, 50 
Pits, 7 

in soldering, 74 
Plaster-of -Paris, 44, 301 

teeth, 45 
Plastic fillings, 10 
Plate clasps, Decay under, <i 
Platinized gold, 68 
Platinous gold, 68 
Platinum, 315 

in dentistry, 70 
solder, 73 
Plethora, 196 
Plumpers, 53 

Pneumogastric nerve, 386, 470 
Points, Excavator, 3 
Poisoning by atropine, 242 

carbolic acid, 239 
cocaine, 239 
strychnine, 242 
Porcelain dentures, 72 

inlays, l v 
Positive elements, 282 

metallic fillings, 329 
Potassium permanganate in dentis- 
try, 223 
Potential, 265, 287 
Preparation of cavities, 2 

mouth for artificial 
denture, 43 
Pressure, Hand, 1 ' 
Mallet, 17 
Preventive treatment of dental 

shock, 6 
Primitive dental groove, 375 
Privy, 424 
Profile record, 98 
Prognosis, 200 
Prosthetic dentistry, 43 
Protection of cavities, 5 

the pulp, 21 
Proteids, 389 
Protoplasm, 359 
Provisional callus, 189 
Proximate principles, 403, 407 
Pterygoid muscles, 44ti 
Ptomaines, 185, 435 
Pulp, 371 

-canal, 24 



INDEX. 



48- 



Pulp, Capping of, 22, 208 

Congested, 20 

Dead, 24 

Devitalization of, 23 

Disease of, 209 

Exposed, 20, 33 

Fungoid, 25, 211 

Hyperemia of, 130, 217 

Irritable, 211 

Irritation of. 21 

Moist gangrene of, 128 

Mummification of, 25 

Painful, 21 

Pathology of, 22 

Protection of, 21 

Putrescent, 26, 207 

Kemoval of, 25 

Stones, 22 

Suppuration of, 217, 219 
Pulpitis, 20, 219 
Pulpless teeth, 26 
Pulse, normal, 393 
Punctured wounds, 140 
Purple of Cassius, 49 
Pus, 186, 195, 213 
Putrescent pulp, 26, 207 
Pyemia, 114, 179 
Pyogenic bacteria, 196 
Pyorrhea alveolaris, 37. 147, 253 
Pyrozone, 216 

Qualitative analysis, 288 
Quantitative analysis, 288 
Quarantine, 430 
Quick pulse, 165 
Quinine, 230 

Rain water, 432 

Ranula, 107, 122, 159 

Ranvier 's nodes, 364 

Red blood corpuscles, 365, 368, 397 

marrow, 345 
Reducing agent, 277 
Refining of gold, 318 
Reflex action, 411 
Regeneration of tissues, 194, 199 
Regulation of the teeth, 88 
Reinsch's test, 317 
Removable bridge, 85 
Removal of gold crown, 79 

of pulp, 25 
Repair of fractures, 198 
Replanting of teeth, 29, 112 
Reposing the features, 46 



Resorption of roots, 218 
Respiration, 394 

Artificial, 129 
Respiratory failure, 111 
organs, 399 
Retainers, 90 

Reticulum of lymphoid tissue, 347 
Retrenchment, 137 
Retzins ' striae, 351 
Richmond crown, 75 
Root amputation, 28 

-canal, 24 
Roots, Resorption of, 218 
Rolando 's fissure, 459 
Rose 's operation, 125 
Rubber, Solvents of, 51 

Weighted, 52 
Rugae in a vulcanite plate, 95 

Saline cathartics, 251 

Saliva, 302, 379, 395, 410 

Salivary calculus, 37, 149, 173, 201, 

215 
Salivary duct, Calculus in, 145 

fistula, 149, 174 

glands, 361, 447 
Salter 's lines, 353 
Sanguinary calculus, 37, 203 
Sapremia, 114 
Saprophytes, 184 
Saprophytic bacteria, 218 
Sarcolemma, 364 
Sarcoma, 184 

Myeloid, 135 

of superior maxilla, 185 
Sarcomatous epulis, 190 
Scarification, 132 
Schreger 's lines, 353 
Schwann 's white substance, 364 
Sciatic nerve, 475 
Secondary dentine, 7, 353, 358 

hemorrhage, 105, 176 
Secretions, 411 
Section-cutting, 345 
Sedatives, 229 
Sensible heat, 271 
Sensitive heat, 7 

anterior teeth, 6 

teeth, Treatment of, 6 
Separation of teeth, 8 
Sepsis, 184 
Septic infection, 200 

intoxication, 117 
pericementitis, 209 



488 



INDEX. 



Septic wounds, 130 

Septicemia, 114, 200, 207, 213 

Sequestrum, 125, 144 

Serous membranes, 370 

Serumal calculus, 203 

Sewage, 432 

Sewer-gas, 420 

Sharpey 's perforating fibers, 350 

Shell crown, 78 

Shock, 167 

Surgical, 106 

to the teeth, 6 
Shoulder-joint, 455 
Sialagogues, 253 
Sigmoid notch, 465 
Silex in dentistry, 95 
Silver, 322 

nitrate, 38, 227, 231, 323 
Simple cyst, 160 

molecule, 285 
Skin, 412 

Smoker 's patch, 166 
Sodium, 324 

silicate, 324 
Soft pulse, 169 
water, 426 
Softening of cavity walls, 15 
Solder, aluminum, 61 
Soldering, 67, 74, 314 
Solvents of rubber, 51 
Spasmodic respiratory failure, 111 
Special pathology, 197 
Specific gravity, 263, 273 

heat, 264, 271 
Spectroscope, 268 
Spectrum analysis, 265 
Sphenoid bone, 442, 467, 468 
Sphenoidal fissure, 464 
Spinal column, 453 
Spirilla, 196 

Sponges, Sterilization of, 138 
Spongioplasm, 356 
Spongy bone, 346, 364 

gums, 127 
Spores, 183 
Sputum, 430 
Squamous bone, 448 
Stain, Green, 33 
Staphylorrhaphy, 105 
Starvation, 397 

Steno 's duct, Cystic dilatation of, 113 
Sterilization of hypodermic syringes, 
192 
instruments, 38, 105 



Sterilization of sponges, 138 
Sternomastoid muscle, 464 
Sternothyroid muscle, 466 
Stimulants, 227, 239 

Diffusible, 258 
Stippling, 71 
Stomach, 380, 390 
Stomatitis, 117, 122 

Gangrenous, 198 
Mercurial, 141, 214 
Stratified epithelium, 349 
Stratum granulosum, 375 

Malpighii, 351 
Strychnine poisoning, 242 
Styloglossus muscle, 476 
Styptics, 231, 251 
Subclavian vein, 451 
Sublingual gland, 447 
nerve, 389 
Submaxillary ganglion, 452 
gland, 469 
secretion, 399 
triangle, -Mis 
Sulphur, 299 
Sulphuric acid in dentistry, 38, 221, 

237, 275, 300 
Sulphurous acid, 275 
Superficial dental caries, 1 
Superior carotid triangle, 476 

longitudinal sinus, 451 
maxilla, 455 

Fracture of, 135 
Tumors of, 141 
Sarcoma of, 185 
thyroid artery, 457 
vena cava, 459 
Suppuration, 188, 195, 214 

of maxillary sinus, 112 
of the pulp, 217, 219 
Suppurative cellulitis, 106 

inflammation, 163, 189 
periostitis, 152 
Supraorbital artery, 469 
Surgical shock, 106 
Surgery, Oral, 101 
Sutures, 124 
Suture materials, 107 
Swaging, 62 
Sweating, 68 

Swelling in inflammation, 176 
Sylvester 's method, 155 
Symbols, 285 

Sympathetic nervous system, 395, 
407, 441 



INDEX. 



489 



Syncope, 105, 167, 168 

Synergist, 236 

Synovitis, 103 

Synthesis, 279, 283 

Syphilis of the mouth, 138, 186 

Syphilitic interstitial gingivitis, 129 

periostitis, 172 

ulcers, 152 

ulcer of the tongue, 104 
Syphilitics, Operations on, 114 
System, Farrar 's, 88 

Tartaric acid, 305 
Teeth, Abrasion of, 7, 210 

Artificial, 46, 49, 50, 55 

Bleaching, 26 

Calcification of, 365 

Cleansing of, 39 

Color of, 26 

Counter-sunk pin, 50 

Deciduous, 219 

Deposits on, 36 

Devitalization of, 210 

Diatoric, 50 

English tube, 66 

Erosion of, 7, 218 

Eruption of, 216, 406 

Examination of, 39 

Extraction of, 30 

Formation of, 361 

Hutchinson 's, 211 

Implantation of, 112 

Irregularity of, 35, 174 

Normal occlusion of, 56 

Plaster, 45 

Pinless, 50 

Pulpless, 26 

Regulation of, 88 

Replanting of, 29, 112 

Sensitive, 7 

Separation of, 8 

Shock to the, 6 

Temporary, 32 

Transplantation of, 112 

Unerupted, 36 

Wedging of, 8 
Temperament and teeth, 47 
Tempering, 311, 325 
Temporal artery, Ligation of, 103 
bone, 448 
fossa, 467 
teeth, 32 

Abscess of, 210 
Temporo-maxillary articulation, 117 



Temporo-maxillary articulation, 
Wound of, 149 

Tenacity, 265 

Tendons, 453 

Tensor palati, 464 

Test for antimony, 317 
for gold, 317 
Thermal, 19, 210 

Tetanus, 123, 147, 205 

Therapeutics, 238 

Thermal test, 19, 210 

Thoracic duct, 476 

Thready pulse, 163 

Thrombosis, 187 

Thrush, 123, 257 

Thyroid gland, 470 

Tic doloreux, 158 

Tin, 340 

" Tin cry, "321 

Tin fillings, 11 

Tincture of iodin, 228 

Tinctures, 248 

Tissue, 354, 366 

Tobacco, 431 

Tomes ' soft fibers, 368 

Tongue, Carcinoma of, 167 
Cysts of, 107 
Gumma of, 167 
Hemorrhage from, 144 
Muscles of, 462 
Papillae of, 373 
Syphilitic ulcer of, 104 
Traumatic ulcer of 104, 

112, 175 
Tumors of, 184 
Wounds of, 132 

Tonics, 239 

Tonsils, 444 

Toothache, 155, 226, 252, 262 

Tooth-extraction, Hemorrhage after, 
118 

Tooth-germ, 359 

Topical remedies, 245 

Torsion, 124 

Foxalbumins, 196 

Toxins, 185, 435 

Trachea, 443 

Transplantation of teeth, 112 

Traumatic dislocation, 128, 146 

ulcer of tongue, 104, 175 

Traumatism, 123 

Treatment of sensitive teeth, 6 

Triad, 278 

Trichloracetic acid, 257 



490 



INDEX. 



Trifacial neuralgia, 115, 172 
Trismus, 123, 153 
Tumors, 110, 193, 201 

of the antrum, 133 
Benign, 166, 190 
of buccal cavity, 186 

parietes, 185 
Epulic, 121 
Fatty, 138 
of the gums, 183 

maxillary sinus, 112 
superior maxilla, 141, 195 
the tongue, 184 
Typhoid fever, 434 
Tyrotoxicon, 435 

Ulcer, 140, 168 

Carcinomatous, 202 

Syphilitic, 152 

of the tongue, 104 

of tongue, 175 

Traumatic, of tongue, 104 
Ulcerative stomatitis, 122 
Underwear, 425 
Unerupted teeth, 36 
Ununited fracture of inferior max- 
illa, 143 

Vaccination, 419 
Vaceuum chamber, 48 
Valency, 284 
Valves of the heart, 396 
Vasoconstrictor nerves, 389 
Vasodilator nerves, 389 
Vegetable life, 288 
Veins, 399, 472 
Velum, Artificial, 92 
Ventilation, 421 
Victoria, 57 
Vidian nerve, 460 



Virulent germ, 193 
Vitriol, Blue, 300 
Volatile oils, 248 
Volatility, 264 
Voluntary muscles, 389 
Vulcanite, 51, 52 

base, 53 

Waste, 381 
Water, 432 

of crystallization, 263 
Wedging of teeth, 8 
Weighted rubber, 52 
Welding, 314 
Wells, 438 
Wharton's duct, Cystic dilatation 

of, 113 
White decay, 4 

fibrous tissue, 363 
Willis 's circle, 461 
Wisdom tooth, Impacted, 128 
Wood alcohol, 306 
Wounds, 102 

of arteries, 146 

Aseptic, 148, 174 

Contused, 102 

Healing of, 156, 194 

Incised, 151 

Lacerated, 102, 143 

Punctured, 140 

Septic, 130 

of temporo-maxillary artic- 
ulation, 149 

of the tongue, 132 

Yellow marrow, 345 

Zinc, 68, 330 

oxychloride, 9 
phosphate, 9 





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